The establishment of an HNPCC register.

Guidelines for the establishment of an HNPCC-register are presented. The aims of a register are discussed. Steps in identification of families and persons at risk are suggested, and possible sources of family and pedigree data are mentioned. The role of a register in surveillance, information of family members and medical colleagues, research and international collaboration are discussed.

Hydrocele in children: indication for operation and surgical technique.

Hydroceles in children less than one year old should only be treated surgically when discomfort occur, as spontaneous remission is to be expected in this age group. Surgery is nearly always indicated in older children. In a consecutive series of 83 children operated for hydrocele, a follow-up study found a 2% recurrence rate, after an average of 5 years observation, despite the ligation of the processus vaginalis at the anulus inguinalis profundus. In that only 7% of the children developed a contralateral hydrocele, routine exploration on this side is deemed unnecessary.

[Familial adenomatous polyposis]. / Familiaer adenomatøs polypose.

Familial adenomatous polyposis is a dominant hereditary disease which includes early development of up to several thousand colorectal adenomas and subsequent development of colorectal adenocarcinoma in all of the untreated cases. In addition, various extracolonic manifestations may be observed. These include epidermoid cysts, osteomas, desmoids and gastroduodenal polyps. Conventional proctosigmoidoscopy is employed as the primary diagnostic method as all of the patients have rectal adenomata. Thereafter colonoscopic examination is undertaken and gastroduodenoscopy is performed on account of the risk of development of duodenal adenomas. Treatment consists of prophylactic colectomy at about the age of 15 years. An ileorectal anastomosis is most frequently made but construction of an ileoanal reservoir may be considered in selected cases. Regular prophylactic control examinations of first degree relatives of affected family members should commence at the age of ten years. Recent demonstration of a specific gene for polyposis on chromosome 5 will, together with demonstration of retinal pigmentation permit early preclinical diagnosis in future. Establishment of the Polyposis Register has resulted in earlier tracing and treatment of the condition and an improved prognosis.

[Occurrence of colorectal cancer among parents of patients with this disease]. / Hyppigheden af kolorektal cancer blandt foraeldre til patienter med denne sygdom.

In order to investigate the influence of a possible genetic factor on the development of colorectal cancer (KRC), a cohort investigation was carried out among parents of patients with KRC. A total of 1,542 patients participated in the investigation. These patients were under the age of 60 years and registered in The Danish Cancer Register as cases of KRC during the period 1982-1984. 96% of the parents of these patients were identified by means of the administrative registers. The parents were then sought in The Danish Cancer Register for cancer during the period 1943-1986. The incidence rates for the Danish population were employed to calculate anticipated number of cases of KRC among these parents. significantly increased frequencies of KRC were found among both the mothers and the fathers, as the standardised incidence ratio was 1.62 in mothers and 1.87 among fathers. As a Danish investigation of spouses of patients with KRC has not demonstrated any increased frequency of KRC among spouses, it is concluded that this finding indicates a possible genetic factor in the etiology of KRC.

[Parietal cell vagotomy and dilatation in duodenal ulcer complicated by pyloric stenosis]. / Parietalcellevagotomi og dilatation ved ulcus duodeni kompliceret med pylorostenose.

In a follow-up study of 32 patients with duodenal ulcer complicated by pyloric stenosis treated by highly selective vagotomy and dilatation of the stricture, we found an ulcer recurrence rate of 19% and a restenosis rate of 7.6% after a minimum of six years of observation. It is concluded, that dilatation can be used as an alternative to former surgical procedures in the treatment of pyloric stenosis and that highly selective vagotomy is still justified in the treatment of some cases of duodenal ulcer.

[Hereditary non-polyposis colorectal cancer]. / Hereditaer non-polyposis kolorektal cancer.

Hereditary non-polyposis colorectal cancer (HNPCC) probably constitutes 5% of all the cases of sporadic colorectal cancer. At present, the diagnosis can only be established on the basis of a family history which should fulfill the "Amsterdam criteria": 1) Colorectal cancer in at least three family members, 2) One family member must be a close relative of the other two, and 3) The diagnosis must have been established prior to the age of 50 years in at least one relative. Other forms of cancer also occur in the HNPCC syndrome, particularly endometrial cancer. The syndrome has a dominant inheritance and, therefore, all close relatives should be submitted to control examinations for the most important forms of cancer associated with the syndrome.

Ileum duplex and Meckel's diverticulum.

In a four-year-old boy perforation of a peptic ulcer occurred in a Meckel's diverticulum located on a duplication of the small intestine. Complications in connection with Meckel's diverticulum and intestinal duplication are discussed, and also the indications for surgery. If the duplication is too large for resection, continuity of passage must be ensured.

Bleeding duodenal ulcer--treatment strategy. A follow-up study.

In a follow-up study of 40 patients operated on for a bleeding vessel in a duodenal ulcer by means of ligation, pyloroplasty and vagotomy, we found that 9 patients (23%) suffered from recurrent bleeding, with a fatal outcome in 7 cases (78%). We conclude therefore that this method is unsuccessful, and if haemostasis is not achieved by endoscopic electrocoagulation operative resection is suggested. Where resection indicates too high a risk to the patient, we suggest that the operative procedure is reduced to ligation of the bleeding vessel combined with a medical vagotomy in the form of an H2-receptor antagonist.

Therapeutic renal artery embolization to relieve metastasis-induced flank pain. Case report.

The beneficial effect of renal artery embolization on flank pain in a patient with terminal colon cancer is described. The indications for the procedure are discussed, including its use in similar cases for temporary improvement of the quality of life.