Biomedical subjects
Publications and source records attributed to J Brenøe.
The case history of a girl aged 16 years with Ewing's sarcoma of a rib is presented. The symptomatology was typical and consisted mostly of moderate and intermittent pain in the thorax. The time elapsing between the first symptoms and the diagnosis was about 18 months and the consequent therapeutic delay was obvious. The importance of early diagnosis in cases of this type is emphasized.
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.
Twenty patients with cancer of the esophagus and/or cardia underwent transmediastinal esophagectomy by blunt dissection without thoracotomy. Resection and reconstruction with gastroesophageal anastomosis was performed in a single stage in 13 cases. The tumor was nonresectable in seven cases, and instead a substernal bypass was performed. The technical maneuvers are described, and the results and possible advantages and disadvantages of the transhiatal method are discussed.
Over a 9-month period 228 men were admitted for acute urinary retention to six different casualty wards in the Copenhagen area. The patients were followed in the corresponding urological departments for one year. Twenty-seven variables were registered for each patient. The cumulative rate of recurrent retention was 56% after one week and 68% after one year. Factors predictive of preserved voiding ability were a retained volume less than 500 ml, a known event provocative of acute retention, and a maximum flow rate of more than 5 ml/s after the retention. The maximum flow rate measured within the first week after the retention was reliable within the follow-up period if the voided volume was 150 ml or more. The etiology of the acute retention was infravesical obstruction in 90% of the patients, and 85% required subsequent surgical treatment. Predictive of surgical treatment for infravesical obstruction were recurrent urinary retention within one week, a volume of retention of more than 500 ml, the absence of a provocative situation prior to the retention episode and nocturia twice or more.
Over a 9 month period 18 women were admitted for acute urinary retention to six different Copenhagen hospitals, serving a population of approximately 700,000 people. Urodynamically 9 patients had underactive detrusor function, 2 had infravesical obstruction and 3 had both underactive detrusor function and infravesical obstruction. In 4 patients bladder and urethral function were not classified. In 10 patients a provocative event preceded the retention episode. Eleven patients developed recurrent retention within 3 months and 7 patients had persistent severe obstructive voiding problems. Best prognosis was found for patients with correctable infravesical obstruction and for patients with minimal symptoms prior to the retention episode.
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.