A clinical epidemiologic study of thyroid carcinoma in Malmö, Sweden

The annual incidence of clinically diagnosed TC in Malm? was, on an average, 2.4 per 100,000 population during the years 1960-1977. This was 1.2 per 100,000 population lower than the corresponding incidence in the whole of Sweden as reported by the National Cancer Registry. The main reason for the difference was suggested to be inclusion in the official figures of autopsy cases and of cases with a benign diagnosis, rather than a true difference in the prevalence of TC. During the later part of the study an increase in the incidence of differentiated TC of approximately 70% was noted. This was considered to be due to increased health awareness and the availability of medical care, because only the number of tumors with less advanced growth increased. The average annual mortality from TC in Malm? was 0.9 per 100,000, which was 0.4 per 100,000 lower than the corresponding official rate in all of Sweden. The difference was suggested to be mainly due to inclusion in the official figures of persons not dying of TC. The mortality did not change significantly during the period of investigation. The percentage distribution by histologic type of tumors clinically diagnosed (N = 104) was as follows: papillary cancer, 65%; follicular, 21%; medullary, 4%; and anaplastic, 12%. The prognosis as estimated by the life table method was worst for patients with anaplastic TC, followed by those with follicular, papillary, and medullary TC. The validity of using the relationship of the tumor to the thyroid capsule (i.e., intrathyroidal and extrathyroidal growth) as a basis for classification into tumor stages was supported in the present study: the mortality in patients with intrathyroidal tumors was lower than in those with extrathyroidal tumors. The definition of occult TC--TC not larger than 1.5 cm, without regard to the relation to the thyroid capsule--was considered inappropriate and a change in the conception of occult TC was proposed. The presence or absence of node metastases in TC did not seem to have major significance for the prognosis. The significance of age for survival was strongly supported in our study. Deaths from TC clinically diagnosed before the age of 60 were infrequent, whereas the disease after this age increasingly often was fatal. This was partly due to a late onset of anaplastic TC and partly to a higher mortality in older than in younger patients with papillary or follicular TC.(ABSTRACT TRUNCATED AT 400 WORDS)     

Reappraisal of a short-wavelength-sensitive (S-cone) recording technique in routine clinical electroretinography

The recording of blue cone (S-cone) responses as described by Gouras and MacKay was slightly modified and incorporated into our routine ganzfeld electroretinogram protocol. We found a mean S-cone amplitude of 5.0µV (range 2.9–6.9µV) and a mean S-cone implicit time of 41.5 msec (range 40–46 msec). Separation between the combined red and green cone (L-M-cone) response and the S-cone response was obtained with blue flash stimuli on a yellow adapting background.     

Cosmetic outcome and breast morbidity in breast-conserving treatment--results from the Danish DBCG-82TM national randomized trial in breast cancer

A total of 266 recurrence-free breast cancer patients from the randomized DBCG-82TM breast conservation trial were called in for a follow-up investigation to study the impact of surgical and radiation treatment factors on the cosmetic and functional outcome after breast conservation. The patients were interviewed and examined after a median follow-up time of 6.6 years, and 194 of them (73%) regarded the cosmetic result as excellent or good. M orbidity assessments showed that breast fibrosis, skin telangiectasia, and breast retraction were significantly associated with a less satisfactory cosmetic result. On univariate analysis, it was found that treatment with a direct anterior electron field produced more morbidity and inferior cosmetic outcomes compared with tangential photon treatment, while increasing breast size was associated with increased breast retraction and breast fibrosis. Treatment characteristics that emerged as independent prognostic factors of a poor cosmetic outcome on multivariate analysis were the use of a direct anterior electron field (OR =2.15, CI 1.25-3.70) and adjuvant systemic therapy (OR =2.13, 1.22-3.71). A significant but relatively low level of concordance was found between the patients' and the clinician's evaluations of cosmetic results but self-assessments of breast morbidity and psychological distress were significantly related to the observed treatment-induced side effects after breast-conserving treatment, indicating that subjective perceptions and observations as reported by the patients are relevant for the identification of treatment factors that impact on normal tissue reactions.     

Neoadjuvant chemotherapy with cisplatin and methotrexate in patients with muscle-invasive bladder tumours

This prospective, randomized study based on two associated trials was designed to evaluate the effect of neoadjuvant chemotherapy with cisplatin and methotrexate with folinic acid rescue or no chemotherapy prior to local treatment in patients with T2-T4b, NX-3, MO transitional cell carcinoma of the bladder. In the first trial, local treatment consisted of cystectomy (DAVECA 8901) and in the other trial the treatment was radiotherapy (DAVECA 8902); 153 eligible patients were randomized. The majority of the patients (89%) completed the protocol. The overall time to progression for all 153 patients was 12.9 months. Median time to progression was 14.2 months with chemotherapy and 11.4 months without chemotherapy. The actuarial 5-year overall survival rate for all 153 patients was 29%, and 29% for both treatment groups. Multivariate analyses showed that T-stage, tumour size and serum creatinine were independent prognostic factors for survival. The cystectomy trial included 33 patients. Median survival was 78.9 months, 82.5 months with chemotherapy and 45.8 months without chemotherapy (p=0.76). The radiotherapy trial included 120 patients. The median survival was 17.6 months. Median survival was 19.2 months in the group receiving chemotherapy and 16.3 in the group not receiving chemotherapy. The 5-year survival rate was 19% in the group receiving chemotherapy and 24% in the groups not receiving chemotherapy (p=0.98). Late toxicity grade 3 or 4 of the bladder was recorded in 25% of the patients (actuarial rate). Neoadjuvant chemotherapy with cisplatin and methotrexate did not significantly improve disease-free or overall survival in 153 randomized patients with invasive bladder cancer.     

Orbital intramuscular haemangioma

PURPOSE: To present the clinical and histopathological characteristics of an intramuscular haemangioma in the extraocular muscles. METHODS: In 1989, an otherwise healthy 21-year-old female developed proptosis of the left eye. Clinical examination revealed a painless, non-compressible, retrobulbar lesion. No discoloration of skin or conjunctiva could be observed. The patient had no history of head injury. She underwent surgery three times over a period of 9 years, without reaching a diagnosis. The tumour increased slowly in size despite the operations and MR imaging suggested a tumour of angiomatous origin. Finally, radical surgery was performed with enucleation of the left eye and excision of affected extraocular muscles. RESULTS: Histopathological examination of the removed orbital tumour showed a mixed type intramuscular haemangioma involving four extraocular muscles. CONCLUSION: We report the first case of an intramuscular haemangioma of the orbit.     

Oral contraceptives and venous thromboembolism: a five-year national case-control study

The objective of this study was to assess the influence of oral contraceptives (OCs) on the risk of venous thromboembolism (VTE) in young women. A 5-year case-control study including all Danish hospitals was conducted. All women 15-44 years old, suffering a first ever deep venous thrombosis or a first pulmonary embolism (PE) during the period January 1, 1994, to December 30, 1998, were included. Controls were selected annually, 600 per year in 1994-1995 and 1200 per year 1996-1998. Response rates for cases and controls were 87.2% and 89.7%, respectively. After exclusion of nonvalid diagnoses, pregnant women, and women with previous thrombotic disease, 987 cases and 4054 controls were available for analysis. A multivariate, matched analysis was performed. Controls were matched to cases within 1-year age bands. Adjustment was made for confounding influence (if any) from the following variables: age, year, body mass index, length of OC use, family history of VTE, cerebral thrombosis or myocardial infarction, coagulopathies, diabetes, years of schooling, and previous birth.The risk of VTE among current users of OCs was primarily influenced by duration of use, with significantly decreasing odds ratios (OR) over time: <1 year, 7.0 (5.1-9.6); 1-5 years, 3.6 (2.7-4.8); and >5 years, 3.1 (2.5-3.8), all compared with nonusers of OCs. After adjustment for confounders, current use of OCs with second- (levonorgestrel or norgestimate) and third- (desogestrel or gestodene) generation progestins when compared with nonuse resulted in ORs for VTE of 2.9 (2.2-3.8) and 4.0 (3.2-4.9), respectively. After adjusting for progestin types and length of use, the risk decreased significantly with decreasing estrogen dose. With 30-40 microg as reference, 20 and 50 microg products implied ORs of 0.6 (0.4-0.9) and 1.6 (0.9-2.8), respectively (p(trend) = 0.02). After correction for duration of use and differences in estrogen dose, the third/second-generation risk ratio was 1.3 (1.0-1.8; p <0.05). In conclusion, use of OCs was associated significantly to the risk of VTE. The risk among current users was reduced by more than 50% during the first years of use. The risk increased more than 100% with increasing estrogen dose, and the difference in risk between users of third- and second-generation OCs, after correction for length of use and estrogen dose, was 33%.     

Dopamine natriuresis in salt-repleted, water-loaded humans: a dose-response study

Aims The purpose of the present study was to define the dose-response relationship between exogenous dopamine and systemic haemodynamics, renal haemodynamics, and renal excretory function at infusion rates in the range 0 to 12.5 μg kg⁻¹ min⁻¹ in normal volunteers. Methods While undergoing water diuresis, eight subjects were infused with 0, 1, 2, 3, 5, 7.5, 10 or 12.5 μg of dopamine kg⁻¹ min⁻¹ over 2 h in a randomized and double-blind fashion. On each study day, renal clearance studies were performed during a 1 h baseline period and subsequently during the second 1 h infusion period. Lithium clearance (CL_Li ) was used to estimate proximal tubular outflow. Results Cardiac output increased with the four highest doses. Mean arterial pressure followed a biphasic pattern with a decrease during the two lowest doses and a dose-dependent increase from the 7.5 μg kg⁻¹ min⁻¹ dose onwards. Effective renal plasma flow increased with all doses of dopamine, but peaked with the 3 μg kg⁻¹ min⁻¹ infusion rate [ from 617 (585–649) ml min⁻¹ with placebo to 915 (824–1006) ml min⁻¹ (means with 95% CI, P<0.001)]. None of the doses changed glomerular filtration rate (GFR). Sodium clearance (CL_Na ) and CL_Li were elevated with the four lowest doses but increased further from 7.5 μg kg⁻¹ min⁻¹ onwards. Compared with placebo, the percentage increase in CL_Na with increasing dose was 77 (5–159), 93 (13–172), 107 (24–190), 121 (60–181), 253 (65–441), 284 (74–494), and 212 (111–312) %, respectively. There were only small, inconsistent decreases in absolute proximal reabsorption rate (APR=GFR-CL_Li ). Fractional distal reabsorption of sodium (FDR_Na=(CL_Li-CL_Na )/CL_Li ) decreased with all doses, reaching its nadir with 7.5 μg kg⁻¹ min⁻¹ [from 95.9 (94.6–97.2) % with placebo to 91.5 (90.0–93.0) % (P<0.01)] whereafter a flat dose-response curve was observed. Conclusions In conclusion, the renal vasodilating effect of dopamine was maximal with 3 μg kg⁻¹ min⁻¹. The dose-dependent attenuation seen with higher doses is consistent with an increased α-adrenergic stimulation opposing the effect on dopaminergic receptors. The present CL_Li studies confirm that dopamine increases proximal tubular outflow. The results suggest that the natriuretic effect of depressor doses of dopamine was primarily caused by attenuation of the increase in distal sodium reabsorption normally seen after an increase in proximal tubular outflow. Pressor doses further increased sodium excretion, indicating the presence of pressure natriuresis at these high doses.