Biomedical subjects
Publications and source records attributed to O Hansen.
A 55-year old woman with a diagnosis of primary Sjögren's Syndrome suddenly developed AV-block III. A diagnostic procedure finally revealed sarcoidosis with multiorgan involvement.
Morbidity and mortality after emergency procedures in 105 patients with perforated colonic diverticulitis were evaluated in a retrospective study. In different stages of diverticulitis (Hinchey classification: I, 8.6%; II, 14.3%; III, 57.1%; IV, 20.0%) mortality was 12.4%. Preoperative sepsis syndrome with leucopenia and disturbed liver function, cardiac risk factors and obesity were independent prognostic factors in multiple logistic regression. Accompanied by immunosuppression the mortality rate remarkably increased to 33%. The stage of peritonitis showed no influence on the prognosis. In multivariate analysis, surgical procedure (primary resection 12.4%. Hartmann's procedure 61.9%, non-resection procedures 25.7%) showed influence only on increased general complications.
PURPOSE: To investigate the prognostic value of T(POT), S-phase time (TS), iododeoxyuridine (IdUrd) labelling index (LI) and DNA index with loco-regional tumour control as the end-point. MATERIALS AND METHODS: Iododeoxyuridine was given to 99 patients with squamous cell carcinomas of the head and neck before the start of radiotherapy. The analysis included FCM parameters (LI, TS, T[POT] and DNA index, n = 87) and LI determined by immunohistology (IHC, n = 45). A hybrid T(POT) was determined by combining the FCM TS and the IHC LI (n = 45). In diploid tumours (n = 39), the FCM LI was underestimated and the FCM T(POT) was overestimated because the flow cytometer was unable to distinguish between tumour and normal cells. The 'tumour LI' was defined as the IHC LI or the FCM LI of aneuploid tumours when a biopsy for IHC evaluation was not available and similarly the 'tumour T(POT)' was determined by the hybrid T(POT) or the FCM T(POT) of aneuploid tumours (n = 63). RESULTS: There was good agreement between the IHC LI and the FCM LI for aneuploid tumours, but there was disagreement for diploid tumours. The median tumour T(POT) was 4.1 days (range 0.6-19.5 days) and the median tumour LI was 12.9% (range 3.1-46.0%). In a univariate analysis there was no prediction of loco-regional tumour control by the LI, the TS or the T(POT) determined by either of the methods. T-classification, N-classification, clinical stage and tumour diameter were related with loco-regional tumour control, whereas clinical stage was the only parameter that yielded independent prognostic significance in a multivariate analysis. CONCLUSIONS: This study does not confirm the significant prognostic value of T(POT) as indicated in some previous reports. Larger clinical studies are needed to draw final conclusions.
Using biopsies of rumen epithelium papillae a net influx of [86Rb+] was measured corresponding to a high concentration of Na+, K(+)-pumps found in [3H]ouabain-binding studies (Kristensen et al. 1995). In the present study the Na+, K(+)-ATPase in papillae homogenates is compared with purified (Na+, K+)-ATPase from different sources, immunochemically characterized with respect to the isoform of the hydrolytic alpha subunit and the concentration of pumps substantiated by a novel immunochemical method. Na+, K(+)-ATPase purified from bovine kidney was shown to contain one homogeneous high-affinity population of [3H]ouabain-binding sites (Kd 1.37 nM). The ouabain-binding capacity was 0.82 nmol (mg protein)-1. Site-directed polyclonal antibodies raised to isoform-specific sequences of the three known alpha-subunit isoforms and monoclonal alpha 1-specific antibodies were used for isoform characterization on western blots of peptides separated by SDS-polyacrylamide gel electrophoresis. All three isoforms were present in Na+, K(+)-ATPase prepared from bovine brain. The alpha isoform of bovine kidney Na+, K(+)-ATPase and of rumen epithelium homogenate appeared to be alpha 1 whereas alpha 2 and alpha 3 were undetectable. Using an alpha 1-specific antibody and 125I-labelled antimouse IgG the content of (Na+, K+)-ATPase in rumen epithelium was determined by comparison of the signal from known amount of bovine kidney Na+, K(+)-ATPase on western blots. By this method rumen epithelium was found to contain 2.6 nmol Na+, K(+)-ATPase (g wet wt)-1, i.e. a similarly high or even higher concentration than previously seen in ouabain-binding studies on biopsies.
AIM: To assess to what extent intra-urban variations and time trends of mortality in ischaemic heart disease are related to incidence of disease. METHODS AND RESULTS: Incidence and mortality data were retrieved from the myocardial infarction register in Malmö. Age- and sex-adjusted incidence varied between the 17 city areas from 469 to 681/10(5) (P=0.003), and mortality from 286 to 446/10(5) (P=0.017). Socio-demographic risk factors for ischaemic heart disease were more prevalent in high rate areas. About 70% of the variance in mortality was explained by the variance in incidence. From 1986 to 1992, incidence declined by 3.6%/year in men (P=0.004) and by 0.9%/year in women (P=0.31). Mortality decreased by 4.1%/year in men (P=0.01) and by 1.9%/year in women (P=0.15). Incidence and mortality changes were statistically significant only in men>65. In younger age groups, incidence and mortality decreased in men but increased in women. CONCLUSIONS: In this urban population, there were large intra-city differences in mortality from ischaemic heart disease. During the period 1986 1992 there was a parallel decline in mortality and incidence. There were, however, substantial variations both in terms of residence and subject.
A total of 1069 patients, 739 with newly diagnosed laryngeal and 330 with pharyngeal cancer, were seen at the Centre for Head and Neck Cancer, Odense University Hospital during the period 1965-1992. Of those with laryngeal carcinoma, 1% (5/499) of the glottic and 29% (68/232) of the supraglottic cases had primary lymph node metastases. The frequency of metastases in patients with primary endolaryngeal tumours was highest at the inlet of the larynx--38%--decreasing gradually distally to 1% at the level of the vocal cords. Metastases occurred among patients with pharyngeal carcinoma in 66% (218/330). All patients received primary radiotherapy, except for the 10 who were subjected to surgery. The calculation of the burden of lymph node metastases was based on the volume formula of an ellipse, and could be carried out on 280 of the 291 patients with metastases. The calculated volumes ranged from 1-1413 cm3. These were divided into 3 groups according to size. A Cox multivariate regression analysis, using crude and disease specific survival as endpoints, revealed the burden of metastasis to be an independent, prognostic factor.
To identify clinical and histologic prognostic factors and to investigate whether immunohistochemical detection of p53 expression might contain prognostic information, a retrospective study of patient and tumor characteristics was performed in 225 cases of papillary and follicular thyroid carcinomas. The analyses were based on cause-specific and crude survival. In univariate analysis, age at diagnosis, tumor size, presence of distant metastases, histology (papillary contra follicular type), extrathyroidal invasion, necrosis in primary tumor, and p53 expression were significant prognostic indicators. For 211 patients (96%) all information was available and Cox's proportional hazard model was applied. The authors found that age, distant metastases, necrosis in primary tumor, extrathyroidal invasion, and p53 expression were significant prognostic factors. Analyses of cause-specific and crude survival gave similar results. The authors conclude that age at diagnosis, presence of distant metastases, necrosis in primary tumor, and extrathyroidal invasion are important prognostic factors, and that immunohistochemical detection of p53 protein in the primary tumor is a significant and independent prognostic indicator, which might be of value in the treatment planning in patients with papillary or follicular thyroid carcinomas.
A total of 115 patients with sinonasal cancer was assessed during the period 1978-1995. Ninety-one patients received treatment with curative intent. A combination of irradiation and operation was used. The 5-year crude survival for patients, who were treated with curative intent, was 41%; the disease-specific survival throughout the period was 48%. Primary irradiation followed by maxillectomy was widely used in the first half of the period. Treatment in the last part was changed to primary lateral rhinotomy with post-operative irradiation whenever possible. Twelve maxillectomies were performed during the first half of the period, and during the last part, only two. Disease-specific survival was equal in the first and the second halves of the period.
Colon diverticulitis showed a great variability in kind, intensity and course of disease. Time and surgical procedure are dependent on the stage of diverticulitis (emergency procedure, elective resection, early elective resection). In emergency cases non-resecting procedures should not be performed. Here the Hartmann procedure and in favorable conditions the primary resection should be chosen. Other patients with acute diverticulitis should have early elective resection after short-term medical treatment (5-7 days). Patients with a chronic-recurrent course of disease should have an elective one-sided resection. The surgical principles are mobilization of the splenic flexure as well as the widening of the distal resection limit into the upper rectum to avoid a recurrence.
In a retrospective study 243 pelvic CTs in patients with acute sigmoid diverticulitis and elective resections were analyzed. A statistical correlation of radiological and histological findings was performed. The sensitivity of the CT in diagnosing sigmoid diverticulitis was 97.5%; the overall accuracy of the pelvic CT was 97.1% in acute diverticulitis. For the contrast enema the sensitivity was 71.6% and the accuracy rate ranked 71.3%. The pelvic CT in patients with clinical suspicion of acute sigmoid diverticulities is well suited for a primary diagnostic tool and can precisely show the extraluminary extension of the inflammation.
Ascending thrombophlebitis of the superficial leg veins is known to pass into the deep veins, causing an embolism to develop. Duplex ultrasonography has been shown to be a reliable technique for the evaluation of superficial venous thrombosis. If progression is noted, crossectomy proved to be effective in preventing passage of thrombi into the deep veins.
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PURPOSE: Accelerated repopulation of tumor cells during radiotherapy has been suggested as an important cause of treatment failure in squamous cell carcinoma of the head and neck. Due to tumor heterogeneity, not all tumors may benefit from accelerated radiotherapy at the expense of a lower total dose. This analysis evaluates the impact of histological differentiation on loco-regional control in relation to treatment duration. PATIENTS AND METHODS: A total of 501 patients with advanced supraglottic and pharyngeal squamous cell carcinoma with known histopathological grading were treated with planned split-course (191 patients) or continuous radiotherapy (310 patients) in two consecutive randomized controlled trials. Irradiation was given 2 Gy per fraction, 5 fractions per week to a dose of 66-68 Gy in 9.5 or 6.5 weeks, respectively. RESULTS: Overall, split-course and continuous treatment resulted in a 5-year loco-regional control of 30% and 41% (P = 0.007), respectively. However, the detrimental effects of split-course were only found in moderately and well-differentiated tumors, where the 5-year tumor controls were 38% and 21% after continuous and split-course treatment, respectively (P = 0.001). In contrast, in poorly differentiated tumors loco-regional control was obtained in 44% of the cases for continuous and 40% for split-course treatment (P = 0.63). CONCLUSIONS: It is suggested that the ability to accelerate repopulation may be lost by dedifferentiation, and that prolongation of the overall treatment time only lead to reduced loco-regional control in well to moderately differentiated tumors.
BACKGROUND AND PURPOSE: In 1986 a prospective, randomized, multi-centre trial for evaluation of neoadjuvant chemotherapy with cisplatin and 5-fluorouracil in the treatment of advanced squamous cell carcinoma of the head and neck was initiated. As survival in this group of patients is poor the purpose was to find a possible survival benefit of the chemotherapy in addition to radiotherapy compared to radiotherapy only. METHODS: Four-hundred sixty-one patients from Denmark, Norway and Sweden with tumors in oral cavity, oropharynx, hypopharynx and larynx were randomized to receive either standard treatment (radiotherapy or radiotherapy followed by surgery) or neoadjuvant chemotherapy followed by standard treatment. Chemotherapy included three courses of cisplatin 100 mg/m2 i.v. infusion on day 1 followed by 5-fluorouracil 1000 mg/m2 per day continuous i.v. infusion for 120 hours. Radiotherapy 64-70 Gy in 2 Gy per fraction, 5 times/week, was given to patients in both treatment arms. RESULTS: Response rate was 71% for patients randomized to chemotherapy-radiotherapy and 66% for patients randomized to standard treatment (not statistically significant). Residual tumors were excised if possible. After surgery 62% of the patients randomized to chemotherapy-radiotherapy and 60% of the patients in the standard treatment group were clinically tumor free. CONCLUSIONS: No statistically significant benefit in survival was observed for patients treated with neoadjuvant chemotherapy followed by radiotherapy. Nor was there any impact of chemotherapy on the number of patients achieving loco-regional tumor control after primary treatment.
Clinical and ergometric data were derived from 1098 consecutive exercise tests in patients with a first acute myocardial infarction between 1974-1983. In 1992 a follow-up was performed in order to analyse the importance of a submaximal early exercise test, in combination with clinical data, for the prediction of short- and long-term prognosis of cardiovascular death. The relative value of 20 clinical variables, including medical history, markers of infarction size, medication etc., and 28 variables at exercise test were studied. Univariate, multivariate and survival analysis, for estimation of prognosis and independent prediction of cardiovascular death was used. Independent clinical risk factors for cardiovascular death were (1) Within 1 year: relative heart volume (ml.m-2 body surface area) on chest X-ray. (2) Long-term mortality: maximum heart rate and relative heart volume, diabetes, age and digitalis medication. Independent exercise risk factors were: (1) Within 1 year: heart rate, ventricular arrhythmia and ST depression > or = 1 mm before exercise, diastolic blood pressure at maximum exercise and target heart rate. (2) Long-term mortality: angina pectoris and/or ST depression > or = 1 mm at maximum exercise. In subgroups of patients with clinical risk factors, mortality risk increased if there were signs of angina pectoris and/or ST depression > or = 1 mm during exercise. The risk increased 100% in diabetics, 91% with age > 70 years, 58% with relative heart volume > or = 500 ml.m-2 body surface area, 42% with heart rate > or = 100 at admission, and 34% with digitalis medication. No increase was found in the subgroup of patients without clinical risk factors. Thus, submaximal early exercise stress testing provides important information for short- and long-term prognosis in patients after the first acute myocardial infarction compared to clinical evaluation alone.
Closure of the surgical defect immediately after partial maxillectomy is the treatment of choice. The advantages are: maintaining facial contour, rapid re-establishment of speech, swallowing and mastication. A number of methods for the fixation of the immediate obturator in patients without teeth have been described. A new technique is reported where a transnasal wire holds the existing denture in position after partial maxillectomy. The method has been carried out on 7 patients with sino-nasal cancer during the period 1978-1994. The advantages of the technique are that the wire acts as an axis of rotation which together with the sponge in the cavity provide good stability of the denture. There is minimal preoperative laboratory work and simplification in replacing the surgical dressing.