Biomedical subjects
Publications and source records attributed to E Kvist.
Among 279 patients with carcinoma of the prostate no relationship was observed in survival between blood groups ABO (H) or the rhesus system. Age at diagnosis is relevant for the outcome of the disease, but grade of differentiation, tumour stage and metastases are more important predictors of survival.
A 64-year-old man presented to the dermatology clinic with primary genital Paget's disease. He was treated conservatively and died of metastases nine years later. The natural history of the lesion is malignant, and radical excision is recommended.
In a retrospective study of 28 women and eight men with squamous cell metaplasia in different parts of the bladder, including the trigone, no histopathological differences were observed among the regions. All the five (female) patients with parakeratosis had a concomitant invasive bladder tumour. Thirty-eight% of all the patients had a simultaneous neoplastic tumour. The metaplastic lesions were investigated for keratin in 13 patients, and all were positive. In seven out of eight patients, the urothelium adjacent to the squamous cell metaplasia was also positive for keratin, indicating a direct transformation of the urothelium to squamous cell epithelium. The metaplastic cells were investigated for oestrogen receptors in five men and five women, and all were negative, suggesting no relationship between estrogens and squamous cell metaplasia of the bladder. Squamous cell metaplasia in the bladder is not considered a premalignant condition. However, metaplasia and neoplastic tumours are often associated with chronic tissue damage, and the presence of metaplasia may give a warning of conditions that can also cause cancer.
In a study of 290 patients with transitional cell carcinoma of the upper urinary tract an excess of blood group A was found. Comparisons between blood group A versus O and rhesus-positive versus rhesus-negative in relation to tumor stages or grades of dysplasia showed no significant differences neither at presentation nor in actuarial survival rates. It is concluded that the blood group systems ABO and rhesus have no prognostic value in urothelial tumors of the upper urinary tract.
A retrospective study of 709 patients with prostatic cancer was carried out. Twenty-two developed medullary cord compression (an incidence of 3%). All but two of the 22 patients were treated by radiation and 10 had additional hormonal treatment. Ten had some benefit from the treatment, but only 2 of 19 regained their ability to walk. The need for immediate diagnosis and treatment is stressed.
In a retrospective study of 198 patients with transitional cell carcinoma of the upper urinary tract, post-operative recurrences developed as contralateral tumours in 2.5%, in the ureteric stump after conservative resection in 19% and in the bladder in 36.4%. Upper tract recurrences resembled the primary tumours in terms of grade and stage; of the bladder tumours, 89% were similar in grade and 72% similar in stage to the primary tumours. Age, sex, grade and stage had no effect on the number of bladder recurrences, but ureteric tumours had significantly more recurrences than renal pelvicaliceal tumours. Sex, bladder recurrences and site of primary tumours did not influence survival. Thus grade and stage of the primary tumour were the only predictive variables of the final outcome.
Six cases of ureteritis cystica are reported. Pathogenesis and diagnosis are discussed emphasizing the papillary tumour as an important differential diagnosis. A conservative attitude is recommended with a follow-up until the intravenous urography has normalized.
In a prospective, controlled, double-blind study, 496 patients undergoing abdominal surgery were given antibiotic prophylaxis with a single dose of either ceftriaxone or ampicillin + metronidazole. No significant intergroup difference was found between the respective overall rates of infectious complications (3.2% and 4.9%). Analysis of the microbiologic findings showed incisional wound infections, mainly caused by gram-negative rods, to be more common in the ampicillin-metronidazole group, whereas deep wound infections were more frequent in the ceftriaxone group. It is concluded that ceftriaxone seems to be more efficient than ampicillin-metronidazole as prophylaxis against incisional wound infection, but should preferably be supplemented with an antianaerobic agent to prevent deep wound infections.
In 295 patients with transitional cell tumours of the upper urinary tract no significant relationship was found comparing blood groups A and O and the rhesus system to histological grade and invasive or non-invasive growth.
The sex- and age-related urinary excretion of pseudouridine/creatinine and beta-aminoisobutyric acid/creatinine was studied in 77 healthy subjects (24 children and 53 adults, 27 of whom were women). The highest values were found in the youngest children. We compared the excretion ratios of pseudouridine/creatinine and beta-aminoisobutyric acid/creatinine in women and men and found no significant differences between them. The excretion patterns may be helpful in the diagnosis of patients with urinary tract tumours and in predicting patients at risk of recurrences.
In 39 patients with either pelvic or renal cell tumours, the pre-operative urinary excretion ratios of pseudouridine/creatinine (psi:C) and beta-aminoisobutyric acid/creatinine (BAIB:C) were estimated. In 34/39 of the patients (87%), including both types of tumours, psi: C was found to be increased, and in only one patient was the value decreased. Twenty-five of the patients (64%) had a BAIB:C ratio within the normal range. 10 (25%) had increased and 4 (11%) decreased values. In 13 patients the psi:C and BAIB:C ratios from the affected side were compared with the values in urine from the bladder. Twelve of the patients had higher values of psi:C in the urine from the ureter. In seven patients the ureteric BAIB:C ratio was higher than the bladder BAIB:C ratio and in five patients the ureteric BAIB:C ratio was less than the bladder BAIB:C ratio. In only one patient were the values similar. The results indicate that patients with tumours of the upper urinary tract have changed excretion patterns compared with normal subjects and the urinary ratios on the affected side are different from those on the healthy side. The biological tumour markers pseudouridine and beta-aminoisobutyric acid may be helpful in the diagnosis of tumours in the upper urinary tract.
Three different types of metaplasia of the urinary bladder are described: nephroid metaplasia, colonic metaplasia and signet-ring cell metaplasia. The latter metaplasia was without any histological signs of malignancy and the patient is still alive without recurrence, 12 years after the diagnosis was made. We believe it is the first published case of benign signet-ring cell metaplasia. The patients with nephroid metaplasia were controlled from 3-18 months without recurrence. Two of the patients with colonic metaplasia were followed from 16 to 132 months; both developed recurrences. In patients with metaplasia of the urothelium, follow-up cystoscopy is recommended because of the recurrent nature of the condition and the malignant potential of metaplastic urothelium.
This article presents a retrospective study of 95 cases of irreducible inguinal hernia in 93 children (median age 0.5 years; range 0-13 years) admitted with this diagnosis. In 38 cases operations were performed without delay, in 51 from 12 to 48 hours after admission, and in 6 cases at a later stage. Thus, a total of 57 patients (60%) could be treated with conservative measures at the time of admission. Three instances of minor wound haematoma which did not require treatment and two instances of pneumonia caused by aspiration were recorded. Eighty-three patients could be traced, 70 of whom responded to our questionnaire. The number of infections was 2 (2.8%) and the number of recurrences was 9 (12.3%). In order to reduce the recurrence and infection rates in emergency cases of irreducible inguinal hernia in childhood, the following treatment strategy is suggested: primarily gentle taxis, combined with sedation, if necessary. If reduction is impossible, surgery should be performed without delay. If reduction is achieved, the child can be discharged after 24 hours of observation and readmitted after one week for elective out-patient herniotomy.
A questionnaire presented to 79 danish surgical departments showed that about 2,000 urethral strictures are treated in Denmark per annum. These were mainly incised by Sachse's method. 8% of the patients do not have postoperative catheterisation, while the remainder have indwelling catheter from 1-28 days, mainly between 1-3 days. The reasons for the chosen regimes are presented.
In 30 boys with a total of 35 maldescended testicles, the present authors found that ultrasonic examination was a useful aid in the diagnosis of maldescended testicles, including intraabdominal testicles. Ultrasonic examination is recommended preoperatively in boys with non-palpable testicles in order to provide optimal surgical intervention.
A retrospective review is presented of 496 children with a median age of 4 years (range 0-13 years) on whom a total of 527 hernia repairs were performed as out-patients. No wound infections were observed, and the rate of early surgical complications was 1.5 per cent. There were 15 (3.7 per cent) known recurrences. No complications from the anaesthetic were recorded. Owing to the negligible infection rate and the low surgical complication and recurrence rates it is concluded that children with inguinal hernia would benefit from operation as out-patients, and that they should be operated on immediately after diagnosis, irrespective of age. Besides probably minimizing the children's psychological trauma, out-patient surgery provided considerable savings to the health service in the present study.
A modification of intussusception ureterectomy is described. Dilatation of the ureter is unnecessary before the procedure and closure of the bladder wall defect is recommended to avoid urine extravasation.
In 497 children with 528 hernia and 190 boys with 241 maldescended tests, outpatient operation was performed in 96.5% and 92.6% of the patients with an immediate surgical complication rate of 1.5% and 0% respectively. No wound infection was observed and the long term result was satisfactory with 3.7% hernia recurrences and 90% of the tests localized in the bottom of scrotum. Orchiopexy at about two years of age and early herniotomy, irrespective of age, is recommended and surgery may safely be carried out on an outpatient basis.