Biomedical subjects
Publications and source records attributed to S L Stephensen.
A possible relation between joint replacement and malignancy has previously been suggested in a few cases. In the majority of these cases, the authors found either malignant fibrous histiocytomas or osteosarcomas. We hereby report the first case of a liposarcoma in the vicinity of a joint prosthesis.
The acute symptoms after whiplash trauma can be explained by the neck sprain, but the pathogenesis of the "late whiplash syndrome" and the reasons why only some people have persistent symptoms more than six months are still unknown. Thirty-four consecutive cases of piskesmaeld injury were examined clinically three times; respectively within 14 days, after one month and finally seven months post-injury. In addition, MRI of the brain and the cervical spine, neuropsychological tests and motor evoked potentials (MEP) were done one month post-injury and repeated after six months, if abnormalities were found. We found the total recovery rate (asymptomatic patients) was 29% after seven months. All MEP examinations were normal. The correlation between MRI and the clinical findings was poor. Cognitive dysfunction as a symptom of brain injury was not found. Stress at the same time as the accident predicted more symptoms at follow-up. We conclude that long-lasting distress and poor outcome were more related to the occurrence of stressful life events than to clinical and paraclinical findings.
The objective of this study was to assess the diagnostic strategy in identifying occult primary carcinomas in metastatic bone disease. The records of 29 patients seen between 1983 and 1993 were reviewed retrospectively. The patients had been evaluated nonuniformly with a wide array of diagnostic procedures. The primary tumor was identified in 22 patients antemortem, and in 2 patients postmortem. In 5 patients a diagnosis of the primary tumor was never obtained. Eleven of the primary tumors were carcinomas of the lung, 3 were prostatic carcinomas, 2 were carcinomas of the breast and 2 were malignant lymphomas. In 4 patients respectively a carcinoma of the kidney, the pancreas, the ovary or the stomach was found. One patient had a carcinoid tumor of the small intestine, and one had a retroperitoneal rhabdomyosarcoma. The average survival time after clinical onset of skeletal metastases was 12 months. We propose a flow sheet to evaluate this category of patients including a medical history, thorough physical examination, routine laboratory tests, chest radiography, bone scintigram, ultrasonography or computed tomography of the abdomen and biopsy of the most accessible metastasis. These tests allowed premortem diagnosis of the primary tumor in 75% of the cases. Biopsy should be considered the last test to be performed.
From January 1984 to December 1986, 383 total hip arthroplasties were performed in 353 patients. Median age at operation was 69 (24-85) years. At follow-up median 78 (62-102) months after operation, 261 patients with 278 arthroplasties were still alive. A questionnaire was sent to all living patients, 258 patients (99 per cent) replied. Fifty-seven patients with 61 arthroplasties complained of pain and were called in for a check-up including x-ray. Including the dead patients a total of six arthroplasties had been revised, two because of aseptic loosening of the cup and three because of loosening of both components. One had been revised because of deep infection. In the patients called in for check-up seven were suspected of loosening of the stem and one of loosening of the cup. Survival analysis according to Kaplan-Meier showed a survival rate of the prosthesis of 98.5 per cent at 61/2 years. It is concluded that the results after total hip arthroplasties with the straight stem Müller prosthesis are satisfactory. The patients from this study will be followed prospectively from now on to investigate the long-term survival of this type of prosthesis.