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C L Mollerup

Publications and source records attributed to C L Mollerup.

At least 19 recordsLinked to original sources
PubMed2001

[Cohort study of fracture risk before and after surgery of primary hyperparathyroidism].

We studied the risk of fracture in 674 patients operated on for primary hyperparathyroidism compared to 2,021 age- and gender-matched controls, matched for age and gender, randomly drawn from the background population. Before surgery, there was an increased risk of fracture (relative risk 1.8, 9% confidence interval 1.3-2.3), but after surgery the relative risk was normalised (RR = 1.0, 0.8-1.3). The increased risk began ten years before surgery and peaked five to six years before surgery. After surgery, there was a temporary increase in the first year, but in the following years the fracture risk was normalised, with a small rise in distal forearm fractures more than ten years after surgery. Primary hyperparathyroidism may have started up to ten years before surgery, and the fracture risk is normalised after surgery.

Adolescent↗
PubMed2001

[TPO immunostaining of the solitary, cold thyroid nodules].

INTRODUCTION: The chance of malignancy in scintigraphically cold thyroid nodules is 2-24%. Differentiation between malignant and benign cytology is difficult. The aim of this study was to evaluate the ability of immunostaining (MoAB47--raised against thyroid peroxidase (TPO)) to differentiate between malignant and benign cells taken from cold thyroid nodules by fine needle aspiration biopsy (FNAB) in order to reduce the number of unnecessary thyroid operations. MATERIALS AND METHODS: One hundred and eighty-one patients (150 female) with a scintigraphically cold, solitary thyroid nodule were entered between 1993 and 1996. Fifty-seven were excluded for various reasons. Material removed by FNAB was stained with MoAB47 and routine staining. Staining of 80% or more of the cells was considered benign, less than 80% was considered malignant. Routine staining of operatively removed material was used as the final diagnosis. RESULTS: A pattern with negative TPO staining was found in all lesions that were subsequently proved to be malignant. In all but one, the lesions subsequently diagnosed as being benign stained positive for TPO. The sensitivity and specificity were respectively 1.0 and 0.99. CONCLUSION: TPO immunostaining of material removed by FNAB is a powerful tool in the differentiation between benign and malignant tumours.

Adolescent↗
PubMed2000

[Marginal primary hyperparathyroidism. Indication for treatment?].

Non familial primary hyperparathyroidism (pHPT) is often diagnosed accidentally by serum calcium screening. Som patients have marginally elevated calcium values, normal renal function, no renal stone disease and no clinical signs of bone disease. Bone densitometry reveals slightly reduced bone mineral content. Long time observation may show no progression. Observation is recommended due to the potentially stationary and symptomfree condition. Recent investigations have however shown that pHPT is associated with cardiac changes and elevated risk of cardiovascular death. Neuropsychiatric changes influencing level of function and quality of life have been demonstrated. There is therefore a substantial need for re-evaluation of the natural course of apparent asymptomatic pHPT and the effect of parathyroid surgery.

Bone Density↗
PubMed2000

Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism.

OBJECTIVES: To study whether fracture risk before and after surgery was increased in patients with primary hyperparathyroidism. DESIGN: Cohort study. SETTING: Three Danish university hospitals. PARTICIPANTS: 674 consecutive patients with primary hyperparathyroidism (median age 61, range 13-89 years) operated on during the period 1 January 1979 to 31 December 1997; 2021 age and sex matched controls from national patient register. MAIN OUTCOME MEASURE: Fractures. RESULTS: The cases had an increased relative rate of fractures compared with the controls before surgery (1.8, 95% confidence interval 1.3 to 2.3) but not after surgery (1.0, 0.8 to 1.3). The risk of fracture was increased for the vertebrae (3.5, 1.3 to 9.7), the distal part of the lower leg and ankles (2.3, 1.2 to 4.3), and the non-distal part of the forearm (4.0, 1.5 to 10.6) before surgery but not after. The increase in risk of fracture began about 10 years before surgery. Risk peaked 5-6 years before surgery and remained raised, although at a lower level, in the five years immediately before surgery. A small increase in risk of fracture of the distal forearm emerged more than 10 years after surgery (2.9, 1. 3 to 6.7). CONCLUSIONS: Risk of fracture is increased up to 10 years before surgery in patients with primary hyperparathyroidism. The risk returns to normal after surgery.

Adenoma↗
PubMed2000

[Primary breast reconstruction in connection with mastectomy for breast cancer. Indication, procedure and immediate surgical results].

Mastectomy and immediate reconstruction of 122 breasts were performed in 109 patients in close collaboration between plastic surgeons and general surgeons. In 56 patients reconstruction was performed using tissue expanders including 13 bilateral operations, 29 patients had a latissimus dorsi myocutaneous flap and 24 a free transverse rectus abdominis myocutaneous flap. There were 27 postoperative local complications in 122 reconstructions (22%), in five the reconstruction was lost. Only patients clinically in stage I were considered for reconstruction. After histopathological staging 27 patients received systemic treatment and 10 local radiotherapy as well. There was no complication during systemic therapy related to reconstruction. In 10 cases local radiotherapy was performed in full, with a delay of four weeks in one patient and a need for correction of the radiation field during treatment in one patient.

Adult↗
PubMed2000

Thyroperoxidase (TPO) immunostaining of the solitary cold thyroid nodule.

OBJECTIVE: To evaluate the value of immunostaining using the monoclonal antibody (MoAB47) against thyroperoxidase (TPO) in distinguishing between benign and malignant tumour cells in fine needle aspiration cytology (FNAC) samples obtained from a solitary cold nodule of the thyroid gland for the purpose of strengthening the indication for thyroid surgery. DESIGN: A prospective, immunocytochemical study of FNACs taken from patients with solitary cold thyroid nodules who presented to Rigshospitalet, Copenhagen, Denmark, during the period April 1993 to May 1996. The first sample series was taken perioperatively in order to test the utility of the method. In the second part of the study samples were obtained preoperatively by ultrasonic guided aspiration. Tissue sections from the nodules obtained during a subsequent operation served as controls. PATIENTS: One hundred and eighty-one patients, 150 women and 31 men, were studied. The age range was 14-89 years with a median age of 44 years. Fifty-seven patients were excluded from the study for various reasons leaving us with a total of 124 nodules from 124 patients for final evaluation. METHODS: FNAC cells and corresponding nodular tissue were stained by immunocyto- and immuno-histochemistry using MoAb47 and by routine staining methods. Samples were considered benign if 80% or more of the epithelial-looking cells of both the FNACs and the histological tissue sections of the nodule were stained by TPO. Consequently, samples were considered malignant if more than 20% of the epithelial-looking cells failed to stain for TPO. Routinely stained tissue cells and sections served as diagnostic controls. RESULTS: A pattern with negative TPO staining was found in all lesions which, by conventional histological staining, were subsequently proven to be malignant. A universal and reliable, positive TPO staining pattern was found in all subsequently proven benign lesions, with the exception of one out of 26 follicular adenomas. This gave the method a sensitivity of 1.0 (negative TPO staining = malignancy in 27 out of 27) and a specificity of 0.99 (positive TPO staining = benign lesion, in 96 out of 97). Positive and negative predictive values were 0.96 and 1.00 respectively. CONCLUSION: Thyroperoxidase immunostaining of fine needle aspirates from solitary, scintigraphically cold nodules of the thyroid gland has proved to be an important and reliable diagnostic tool for distinguishing between benign and malignant nodules. Thus, patients might be spared further surgery if not otherwise indicated.

Adolescent↗
PubMed1999

Renal stones and primary hyperparathyroidism: natural history of renal stone disease after successful parathyroidectomy.

The aim of the study was to evaluate the risk of renal stone recurrence after successful surgical treatment of primary hyperparathyroidism (pHPT). Of 297 consecutive patients with surgically verified pHPT, 151 patients had had renal stone disease; a total of 113 patients were eligible for follow-up; and of these, 107 patients remained normocalcemic during follow-up and formed the study group. The number of new stones were calculated by subtracting the stones present on preoperative urograms from the number of stones on urograms after 1, 3, and 5 years and the number of stones passed or eliminated by intervention. Among 107 patients, 32 (30%) formed one to four new stones within 5 years. This recurrence rate is comparable to the expected recurrence rate in idiopathic stone formers. Primary hyperparathyroidism and renal stone disease are common. As all renal stone formers are screened for pHPT by serum calcium analysis, the two diseases might by coincidence be found in the same patients. A considerable number of patients with pHPT and renal stone disease therefore experience recurrence of their stone disease irrespective of the presence of normocalcemia after successful parathyroidectomy.

Adolescent↗
PubMed1997

[Surgical treatment of primary hyperparathyroidism].

Neck exploration due to suspicion of primary hyperparathyroidism (pHPT) was performed in 309 instances (298 patients) during a 17 year period, in 44 instances (14%) as a second operation after former goitre surgery or surgery for pHPT. Adenomas were found in 247 patients (83%), 12 patients had double adenomas and one triple adenoma. Hyperplasia was registered in 34 patients (11%) and three had parathyroid cancer. Median weight of adenomas was 1200 mg and hyperplasia 1500 mg. In 14 patients only normal glands were identified. In six of these 14 patients the diagnosis was later withdrawn. In 276 out of 292 patients with pHPT normocalcaemia was established, 16 patients remained hypercalcaemic. Success-rate concerning verification of pHPT was therefore 97% (284 out of 292) and concerning attainment of normocalcaemia 95% (276 out of 292). There was one perioperative death due to myocardial infarction. Four patients had transient unilateral recurrent nerve injury. In one patient with parathyroid cancer vocal cord paralysis was permanent. Follow-up after at least one year revealed normocalcaemia in 91% of the patients, hypercalcaemia in 7% and hypocalcaemia in 2%. Twenty percent of the patients had died 0-12 years, median 2.8 years postoperatively. Death was related to the degree of hyperparathyroidism evaluated by weight of abnormal parathyroid tissue.

Adenoma↗
PubMed1996

[Preoperative scintigraphic localization of hyperfunctioning parathyroid glands].

Preoperative identification of hyperfunctioning parathyroid glands was performed by 99m-Tc-sestamibi scintigrams in 29 patients with hyperparathyroidism. Out of 30 histopathologically proven diseased parathyroid glands 21 were identified by scintigraphy. The diagnostic specificity (PVpos) was 88%. All diseased glands weighing more than 1200 mg were identified by scintigraphy including four glands in the mediastinum. 99m-Tc-sestamibi scintigraphy can identify the larger hyperfunctioning parathyroid glands with high reliability. The method was of great value in situations with ectopic abnormal parathyroid glands.

Adult↗
PubMed1994

Primary hyperparathyroidism: incidence and clinical and biochemical characteristics. A demographic study.

OBJECTIVE: To give a demographic description of primary hyperparathyroidism (pHPT) in a region in which the incidence of operative treatment was low (2/100,000 inhabitants/year) and to describe the association between histology, biochemistry, and morbidity among the patients. DESIGN: Retrospective study. PATIENTS: 107 consecutive patients who were operated on for pHPT referred for surgery during an 11 year period in a population comprising one million people. RESULTS: The median weight of adenomas was 1,300 mg (range 200-13,500), weight o hyperplastic tissue removed was median 1,500 mg (range 100-23,800). Weight of abnormal parathyroid tissue correlated significantly with preoperative serum calcium concentration (r = 0.50, p < 0.001). Preoperatively serum immunoreactive parathyroid hormone concentration was correlated with serum calcium concentration (r = 0.39, p < 0.001) and with serum creatinine concentration (r = 0.52 p < 0.001). In a quarter of the patients the serum calcium concentration fell below 2.0 mmol/l after operation. In this subgroup the weight of pathological parathyroid tissue was significantly higher than among those who did not develop hypocalcaemia. Preoperative serum calcium concentration was unrelated to postoperative hypocalcaemia. CONCLUSION: Patients from an area in which few operations are done for pHPT had biochemically and clinically advanced disease compared with patients from comparable areas in which more operations are performed. There is a good correlation between biochemistry, organ involvement, and histology. The serum concentration of calcium preoperatively seems to underestimate the presence of advanced disease in patients in whom the bones are affected.

Adenoma↗
PubMed1993

[Primary hyperparathyroidism. An underdiagnosed disease in Denmark?].

Population-based investigations measuring serum calcium levels seem to indicate a prevalence of primary hyperparathyroidism (pHPT) of 0.4-1% in adults with a figure of about 3% in women over 60 years of age. Annual incidence rate varies and is found to be about 25-30 new cases per 100,000 adults with routine use of serum calcium measurements in diagnostic work-up. In women over 60 years of age the incidence approaches 200 instances per 100,000 individuals. Autopsy studies have demonstrated parathyroid disease in about 10%, one third as solitary adenomas and two thirds as hyperplasia. Annual incidence of surgical interventions, however, is currently found to be low with a frequency of about 2 instances per 100,000 inhabitants in Denmark, but with somewhat higher figures in Sweden and Finland. Recently, the preoperative diagnosis of pHPT has been considerably simplified and requires in most cases solely the demonstration of sustained raised serum calcium levels associated with elevated serum concentration of intact PTH. Investigations indicate that pHPT is underdiagnosed in Denmark, and indications for surgical treatment appear to be restrictive. Compared with Swedish operation series the weight of parathyroid adenomas in Danish series is found to be 3 times higher and the mass of hyperplasia 9 times higher consistent with significantly more elevated serum calcium concentrations. Arguments are presented in favour of an increased interest in diagnosing pHPT and a more liberal approach in the selection of patients for surgical treatment of mild or even asymptomatic disease. Routine measurement of serum calcium concentration in blood samples from patients might be considered in order to increase the incidence rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Gastrointestinal hemorrhage due to fistula from aortic aneurysm. Case report.

Two cases of gastrointestinal bleeding due to aortic aneurysm with fistula to the duodenum are reported. When upper gastrointestinal fiberendoscopy rules out the commonest sources of bleeding but reveals no specific lesion, sonography is advisable. Accurate diagnosis and timely treatment are prerequisites for a successful outcome in this otherwise fatal condition.

Aged↗
PubMed1985

Upper gastrointestinal hemorrhage associated with pancreatitis.

In a two-year period from June 1981, two cases of acute upper gastrointestinal bleeding caused by pancreatitis were observed. In both cases the bleeding was caused by erosion of the gastric mucosa contiguous to, respectively, a pseudocyst and an abscess of the pancreas. Both patients were successfully treated with cystogastrostomy. Erosive bleeding from gastrointestinal mucosa adjoining pancreatic lesions may be a more common source of upper gastrointestinal bleeding than has hitherto been assumed.

Abscess↗