[Vestibular schwannoma. A new interpretation of tumor growth]. / Vestibularisschwannomer. En ny fortolkning af vaekstresultater.

INTRODUCTION: The goal of the present paper was to investigate the growth of vestibular schwannoma (VS). MATERIAL AND METHOD: A series of 123 patients with 127 tumours were allocated to the wait and scan group in the period 1973 to 1999. The material was updated three times medio 1993, medio 1996 and medio 1999. Via the Danish national register, data on whether the included patients were alive or dead were collected medio 1999. Three sets of growth results were obtained. RESULTS: The results medio 1993 revealed: tumour growth in 94 tumours (74%), no growth in 23 tumors (18%) and negative growth in 10 tumors (8%). Medio 1996 the results changed to: tumour growth in 104 tumors (82%), no growth in 15 tumours (12%) and negative growth in eight tumours (6%). The growth figures changed again in medio 1999 to: tumour growth in 108 tumours (85%), no growth in 11 tumours (9%) and negative growth in eight tumours (6%). However, the results may also be interpreted in another way: 52 patients (42%) are alive, tumour growth did not demand any intervention, 23 patients (19%) died due to non-tumour related causes and 35 patients (28%) were previously treated and alive by the termination of the third observation period. CONCLUSION: It is concluded that tumour growth is time dependent, surgery at diagnosis is the ultimate solution, however the current study provides a number of arguments in favour of the wait and scan policy.

[The Bird's Nest vena cava filter: preliminary experiences]. / Bird's nest vena cava-filter: praeliminaere erfaringer.

We report our preliminary experience with the Bird's Nest inferior vena cava filter. Six patients, three men and three women, mean age 71 years (range 25-86), were considered for a Bird's Nest Filter during a 28-month period. Indications were contraindications to anticoagulation in two patients and insufficient effect of anticoagulant therapy in four patients. Three patients succumbed before filter placement. Two filters were placed percutaneously via the right common femoral vein and one via the left common femoral vein. All three filters were inserted successfully without complications. One patient died of multi-organ-failure 25 days after the filter insertion. Two patients are without any complaints and have normal ultrasound examinations 90 and 350 days after filter placement. It is uncommon to insert IVC filters in Denmark, we recommend that it be done by interventional radiologists.

[Microsurgical laser treatment of Zenker's diverticulum. Economic aspects]. / Mikrokirurgisk laserbehandling af Zenkers divertikel. Okonomiske aspekter.

Zenker's diverticulum (hypopharyngeal/proximal oesophageal diverticulum/pouch) is a relatively uncommon cause of dysphagia usually in elderly patients. We describe the results of the first 10 patients operated for ZD with micro-endoscopic laserdiverticulotomy (LD), where the "spur" between the diverticulum and oesophagus is coagulated by means of a CO2 laser in our department. The results are compared with the results of the last nine patients operated with conventional diverticulectomy (DE) via incision on the neck. Two patients in the DE group had complications (wound infection and pneumonia), whereas no complications were seen in the LD group. An initially good result was seen in all the patients in both groups. Symptoms recurred in 11% in the DE group (one patient), whereas this was seen in 20% of the patients in the LD group (two patients). Re-operation of these two patients in the LD group relieved the patients of symptoms, but one patient was re-operated twice before this was achieved. Surgery time was reduced by 64%. Hospitalization time was shortened from a median of 16 (9-28) days with DE to 4 (0-9) days in the LD group. These factors represent a substantial economic saving by using LD as compared to DE. To be able to evaluate the result of LD roentgenographically, it has proven necessary to produce a pure lateral view of the diverticulum both pre- and post-operatively. The size and shape of the diverticulum is mostly seen as unchanged following surgery. With a pure lateral projection, it is however possible to see how the spur between the oesophagus and the diverticulum is diminished with resulting enhanced passage of contrast and practically no retention.

[Occurrence of renal artery stenosis in patients with peripheral arteriosclerosis and hypertension]. / Forekomst af nyrearteriestenose hos patienter med perifer arteriosklerose og hypertension.

The aim of this study was to evaluate the prevalence of renal artery stenosis in patients with clinical signs of peripheral vascular disease and hypertension. One hundred patients, mean age 69 years (range 45-88) with symptoms and clinical signs of severe peripheral ischaemia, underwent aortography to determine the degree of peripheral vascular disease and possible renal artery stenosis. History of claudication and measurement of systolic distal blood pressure and calculation of the Ankle Brachial Index was used to define the severity of peripheral vascular disease. Thirty-one percent had renal artery stenosis (14% greater than 50% reduction in luminal diameter). In a subgroup of patients with hypertension and peripheral vascular disease (n = 74), 34% had renal artery stenosis. In the subgroup of patients with renal artery stenosis, 81% had hypertension. Among patients with renal artery stenosis and lumen reduction of more than 50%, 93% had hypertension (p < 0.001). In conclusion this study shows that the combination of peripheral vascular disease and hypertension is an important clinical clue for renovascular disease. Examination for renovascular disease in this population should be considered, since the prevalence of the condition is high. Furthermore, examination for renal vascular disease in this population is mandatory, before treatment with angiotensin converting enzyme inhibitors is initiated, since treatment might lead to serious renal function impairment.

[Post-traumatic pseudoaneurysm of the posterior tibial artery]. / Posttraumatisk pseudoaneurisme på arteria tibialis posterior.

A case of post-traumatic pseudoaneurysm of the posterior tibial artery is presented. The diagnosis was made by ultrasound one week after the trauma, and a vascular reconstruction was performed. The purpose of this case report is to bring attention to this complication to vascular trauma, which may cause delayed symptoms long time after the injury. We suggest that these patients should be treated with vascular reconstruction rather than ligation, thereby preserving the function of this artery.

[Acoustic neurinomas/vestibular schwannomas. Diagnostic evidence vs. surgery]. / Acusticusneurinomer/vestibularisschwannomer. Observation versus kirurgi.

+-f having vestibular schwannoma (VS) was conducted in a series of 123 patients (127 tumours), over a 20 year-period from 1973 to 1993. Mean follow up period was 3.4 years, mean annual growth rate was 3.2 mm/year. Tumour growth was observed in 90 patients (94 tumours, 74%), no growth was seen in 23 patients (23 tumours, 18%) and negative tumour growth in 10 patients (10 tumours, 8%). Surgery due to tumour growth was performed in 35 patients (35 tumours, 28%). Seven patients (seven tumours, 6%) were treated with gamma radiation and/or shunt insertion. Seven patients (6%) died of brainstem herniation induced by tumour compression. Nine patients (7%) died of non tumour related causes. Twenty-eight patients were classified as candidates for hearing preservation surgery and 21 patients (75%) lost their candidature during the observation period due to tumour growth and/or deterioration of hearing. The results may limit indications for allocation of patients with VS to the "wait and see" group.

[Congenital duodenal obstruction caused by an abnormal superior mesenteric vein]. / Kongenit duodenal obstruktion forårsaget af abnormt forløbende vena mesenterica superior.

A case of congenital duodenal obstruction caused by an abnormal superior mesenteric vein is presented. The obstruction was successfully treated by duodenoduodenostomy anterior to the vein.

[Can ultrasonic scanning replace phlebography in the diagnosis of deep thrombophlebitis of the leg?]. / Kan ultralydskanning erstatte flebografi til diagnostik af dyb tromboflebit i underekstremiteterne?

Until recently, phlebography with contrast agents has been the standard method for demonstration of deep venous thrombosis in the lower limb (DVT). In recent years, however, this has been replaced to an increasing extent by ultrasonic scanning. In contrast to radiographic examination, this method does not require injection of a contrast agent and it does not employ ionizing irradiation. The principle of ultrasonic scanning is that a normal vein may be compressed flat by means of slight pressure from the transducer whereas a vein filled with thrombi cannot be compressed. Ultrasonic examination is not (yet?) of diagnostic value in the leg but, more centrally, it is of the same diagnostic value as radiographic examination. It is suggested that ultrasonic scanning can replace phlebography in patients with their first DVT. If this gives a negative result, it may possibly be supplemented by phlebography of the veins of the leg.

[Delayed diagnosis of bronchial foreign body]. / Sen diagnostik af bronkialt fremmedlegeme.

An open safety pin was found in the middle lobe bronchus in a 3-year old girl with pneumonia. The point was directed downwards, and the pin could be removed during bronchoscopy. The lock was found to be partly corroded following months in the bronchial tree. The safety pin had thus most probably been closed when aspirated, and had thereafter remained silent until its spontaneous opening.

Aorto-femoral digital subtraction angiography in old patients with symptoms of peripheral arterial disease. Findings, efficacy, and consequences.

Seventy-four patients between the ages of 75 and 88, with disabling intermittent claudication or critically ischaemic legs underwent an aorto-femoral digital subtraction angiography (DSA). Thirty-six procedures were intraarterial and 38 were intravenous. There were no major complications. The degree and localisation of the arterial lesions did not differ from earlier reports based on conventional arteriography. In 67 patients, on the basis of the DSA examination, a decision could be made as to whether vascular surgery was feasible. In 28 of 57 non-diabetic patients (49%), invasive treatment was carried out in the form of vascular reconstruction, thromboembolectomy, or percutaneous transluminal angioplasty. None of the 17 diabetic patients could be treated invasively.