[Survey of clinical diagnoses and autopsy findings. Autopsy findings and sensitivity, specificity and predictive values for clinical diagnosis during the periods 1 July 1980-30 June 1081 and 1 July 1990-30 June 1993]. / Undersøgelse af kliniske diagnoser og obduktionsfund. Obduktionsfund og sensitivitet, specificitet og proediktive voerdier for klinisk diagnostik i perioderne 1.7.1980-30.6.1981 og 1.7.1990-30.6.1993.

The sensitivity, specificity and clinical accuracy of clinical diagnoses were determined and compared for two periods of time: 1.7.1980-30.6.1981 and 1.7.1990-30.6.1993 based on the analysis of 286 and 138 autopsies respectively. The autopsy rate decreased from 82.7% in the first period to 11.2% in the second. The first period shows a generally higher sensitivity and accuracy for positive diagnosis. Both periods reveal the lowest sensitivity for pulmonary embolism and the lowest accuracy for positive clinical diagnosis of pneumonia/bronchopneumonia. For malignancies and arteriosclerotic heart diseases significant discrepancy between the periods was demonstrated using the chi 2-test. The results are influenced by low autopsy rates causing fewer true-positive diagnoses and a declining sensitivity. This type of study is a useful tool for demonstrating changes in the diagnostic procedure. The present investigation demonstrates a need for further analysis of malignancies to explain the simultaneous decrease in sensitivity, specificity and accuracy in spite of an increasing number of malignancies in autopsy findings.

[Importance of the autopsy rate. A comparison between clinical assessment and findings at autopsies during the periods: 1 July 1908--30 June 1981 and 1 July 1990--30 June 1991]. / Obduktionsfrekvensens betydning. Sammenligning mellem klinisk vurdering og obduktionsfund i perioderne 1.7.1980-30.6.1981 og 1.7.1990-30.6.1991.

On the 1.7.1990 a new law was introduced in Denmark whereby specific consent had to be obtained from the deceased's relatives before autopsy could be performed. Autopsy records from two periods before and after this date, namely from 1.7.1980 to 1.7.1981 and from 1.7.1990 to 30.6.1991, are examined here with respect to autopsy rate and agreement/disagreement between clinical assessment as to cause of death and findings on autopsy. With an autopsy rate of 82.7% before and 10.3% after the new law we found that there was significantly more disagreement between the clinical assessment and the autopsy findings in the 1990/1991 period, presumably because of a selection bias towards difficult cases. The autopsy material from 1990/1991 could only be used for statistics in a limited fashion. A very low autopsy rate of about 10% implies that 25-30% of all death certificates from hospitals must be assumed to be incorrect as concerning serious diseases. The study shows that there is a considerable need for the performance of autopsies for the sake of medical statistics.

[Social and psychological rehabilitation of patients with chronic brain lesions caused by organic solvents: a Danish experience]. / Rééducation sociale et psychologique des victimes de lésions cérébrales permanentes par solvants organiques: une expérience Danoise.

The project concerned social and psychological treatment of patients with chronic health injuries of medium-severe character as a consequence of work with organic solvents. The treatment involved the spouse of the patient and their children, and took place in the family's home, often together with the family doctor, the children's teachers and other people. At a first step, the preliminary examinations have been carried out in the Clinic of Occupational Medicine, Aalborg Hospital, and a diagnosis has been made. In the light of the examinations, patients and their families were selected. The 19 patients and their families participated in the treatment for about 6 months. In other words, the project was divided into four phases, each dealing with 5 patients and their families. The treatment concerned the health status of the patients and the social, psychological and financial situation of their families as well. The results were better when the treatment followed immediately the diagnosis.

Skin carcinogenesis in rats by 3-methylcholanthrene and 7,12-dimethylbenz(alpha)anthracene. Influence of dose and frequency on tumour response and its histological type.

Skin tumours were induced in male inbred rats of the Lister and Wistar strains and in (WixBN) F1 hybrids by topical application of 3-methylcholanthrene (MCA) and 7,12-dimethylbenz(alpha)anthracene (DMBA). Several schedules of application were compared. At a weight basis DMBA was more potent than MCA and the tumour response to DMBA was most clearly related to total dose applied, while the frequency of application was very important for the tumour crop on MCA-treated rats. DMBA led to a marked predominance of squamous celled tumours (SQCT) when treatment was potent, while basal celled and adnexal tumours (BCAT) prevailed after any dosage of MCA. The carcinogenic effect of DMBA in a low total dose approached that of the most potent dosage of MCA. At this level of activity DMBA induced more BCAT than SQCT in both strains and in the hybrids, while MCA induced an increased number of SQCT. Strain differences did not interfere with these main results.

Effect of some fatty acid methyl esters on gastrointestinal carcinogenesis by N-methyl-N-nitro-N-nitrosoguanidine in rats.

Methyl linoleate hydroperoxide (MLHP) and native methyl linoleate (ML) were tested for carcinogenicity toward the gastrointestinal (GI) tract in male specific-pathogen-free outbred Wistar rats. N-Methyl-N-nitro-N-nitrosoguanidine (MNNG) was given in the drinking water in a dose of 20 mg/liter when cocarcinogenic properties of the test substances were to be tested. MLHP and ML were fed by stomach tube and had no effect as complete carcinogens. Given concomitantly with MNNG, ML did not enhance carcinogenesis. MLHP in conjunction with MNNG was the only treatment which, as treatment with MNNG in a dose of 83 mg/liter, led to an increase of GI cancers in animals that died before day 354. Cumulative results after a maximum of 612 days showed a distribution of GI cancers in favor of the glandular stomach only after MLHP was given with MNNG.