[The connection between delayed diagnosis of lung cancer and the intraoperative stage]. / Sammenhaengen mellem forsinket diagnose af lungecancer og stadium på operationstidspunktet.

The five-year survival after surgery for non-small cell lung cancer is good with respect to Stage I and Stage II and poor with respect to higher stages. The aim of this retrospective study of 172 patients was to detect a connection between the intraoperative stage and the pre-operative delay. Concerning the intervals from first symptom to operation and from first contact with the healthcare system to operation, the delay was significantly shorter for the patients in Stage I and II compared to Stage III and IV. The fraction of lung cancers detected by coincidence was significantly higher in Stage I and II compared with Stage III and IV. In conclusion, a few months' delay before final treatment of a non small-cell lung cancer has an impact on the perioperative stage, and thereby on the patient's prognosis. Screening asymptomatic risk-group patients will result in recognition of early lung cancer.

The impact of delayed diagnosis of lung cancer on the stage at the time of operation.

OBJECTIVE: The purpose of this investigation was to study the correlation between diagnostic delay and the stage of the lung cancer at the time of operation. A second objective was to study differences in symptoms between the patients grouped according to stage. METHODS: A total of 172 patients consecutively admitted for surgery between 1 January 1994 and 1 June 1995 at the Department of Thoracic and Cardiovascular Surgery of Rigshospitalet National Hospital of Denmark were included in the retrospective study. Two groups of patients were compared, one group with good prognosis (patients in Stages I and II) and one group with poor prognosis (patients in Stages III and IV). The time-spans studied were: (1) interval from the patient's perception of the first symptom to operation; and (2) the time from first contact with the healthcare-system to operation. The median delay between the patient-groups was compared using the Mann-Whitney U-test. To compare the symptoms which brought the patients in contact with the healthcare-system, the chi2-test was used. RESULTS: In the time interval between appearance of the first symptom and operation, a significantly shorter median delay was found for patients with Stages I and II compared to Stages III and IV (P = 0.037). Concerning the interval from first contact with the healthcare system to operation a significantly shorter median delay was found for the group of patients in Stage I and II compared to the patients-group in Stage III and IV (P = 0.017). It was found that the cancer was an accidental finding, significantly more often in patients in Stages I or II compared to patients in Stages III or IV (P = 0.0002). CONCLUSIONS: A few months delay before final treatment of a non-small-cell lung cancer seems to have an impact on the perioperative stage of the cancer, and thereby on the patients prognosis. A screening of asymptomatic risk-group patients will result in recognition of early lung cancer.

Impalpable breast lesions diagnosed by mammography: incidence of histologically confirmed malignancy.

OBJECTIVE: To evaluate the suitability of currently applied mammographic criteria for the early diagnosis of subclinical tumours by comparing radiological findings with the final histological diagnosis. DESIGN: Open study. SETTING: District hospital, Denmark. SUBJECTS: 151 Women who underwent needle biopsy of 161 occult breast lesions that had been diagnosed by mammography during the period 1986-90. INTERVENTIONS: Definitive operation if frozen section at the time of needle biopsy indicated malignancy. Radiographic examination of the specimen ensured that the abnormal area had been excised. MAIN OUTCOME MEASURES: Correlation of mammographic and histological findings. RESULTS: Eight foci showed carcinoma in situ and 33 invasive carcinoma; 10 of the 33 had lymph node metastases. Foci with mammographic masses had a significantly higher risk of malignancy than those without (25/70, 37%, compared with 8/91, 17%, p = 0.005). Spiculated foci with clustered calcifications had the highest risk of malignancy (6/11, 54%). 16/87 foci in women less than 50 years old contained malignant disease compared with 25/74 in women aged 50 or more (p = 0.04). A fifth of the frozen sections contributed nothing to the diagnosis. The incidence of malignant disease in impalpable lesions of a quarter is similar to the reported incidence in palpable mammary tumours, but metastases at the time of diagnosis are appreciably less common (30% compared with 50%). CONCLUSION: The currently applied mammographic criteria are particularly helpful to patients under the age of 50.

[Vasectomy using the Li method]. / Vasectomia ad modum Li.

The no-scalpel vasectomy is described and evaluated. Nineteen out of 21 consecutive patients could be operated with this technique. The median operating time was 16 minutes, range 9-50 minutes. There were no complications and the scar was barely visible after ten days. The median score for pain was 0.4 cm (range 0.0-5.0 cm) and for discomfort 0.7 cm (range 0.0-5.0 cm) on a 10 cm long visual analogue scale. The method is minimally invasive and well-tolerated by the patients. When some routine is gained the operating time is short.

PIP: The no-scalpel vasectomy developed by Shunqiang Li was used in a prospective, nonrandomized study on 21 patients with the average age of 38 in the out-patient surgery department of the Sundby Hospital, Copenhagen, Denmark, during March 1-July 15, 1993. The necessary instruments were tongs with a ring at the top and pointed scissors for skin penetration and extraction of the ductus deferens (DD). For local analgesia 3-4 ml of intracutaneous 2% lidocaine injection was used. Two patients were excluded because they could be vasectomized on only one side. One of the two was operated on in a conventional method on one side by means of scrotal obstruction, while for the other vasectomy failed because of pronouncedly atrophic testicles. 19 out of 21 consecutive patients could be operated bilaterally with the no-scalpel technique. The median operating time was 16 minutes (range 9-50 minutes), and the last 10 were operated on in 13 minutes. There were no complications and the scar was barely visible after 10 days. The median score for pain was 0.4 cm (range 0.0-5.0 cm) and for discomfort 0.7 cm (range 0.0-5.0 cm) on a 10 cm long visual analogue scale. All patients resumed their normal activities the day after the operation. One patient had soreness in the first postoperative week. To acquire the necessary skills about 10-15 operations are needed, which can be a problem in Denmark where vasectomy is performed in a limited number of cases with large time intervals. The most difficult technical part is the securing of DD with the tongs at midline without the scrotum contracting. Once learned, the method is quick, minimally invasive, well-tolerated by the patients, and economical. Once routine, the operating time is short.

Elective cholecystectomy increases plasma amino-acid clearance and hepatic capacity for urea synthesis for one week.

The importance of the liver in post-operative catabolism was studied in 6 cholecystectomy patients given a mixture of amino-acids as prime-continuous infusions pre-operatively and on the 1st, 3rd, 6th and 12th post-operative day. The plasma clearance of total alpha-amino-nitrogen and of single amino-acids, the urea-nitrogen synthesis rate, and the functional hepatic nitrogen clearance were calculated. Surgery decreased fasting blood amino-nitrogen concentration by 15% (p < 0.01), and increased the plasma clearance of amino-nitrogen by 30% (P < 0.05) on the 1st, 3rd and 6th post-operative day. Surgery doubled the functional hepatic nitrogen clearance (p < 0.01) on the 1st, 3rd and 6th post-operative day. This indicates that post-operative stress catabolism is partly due to a hepatic condition by which the liver eliminates more amino-nitrogen despite lower amino-acid concentration in the blood, for one week post-operatively.