Preoperative PET/CT in early-stage breast cancer.

BACKGROUND: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer. PATIENTS AND METHODS: A total of 103 consecutive patients with newly diagnosed operable breast cancer with tumors ≥2 cm were independently examined preoperatively with conventional assessment (mammography, breast/axillary ultrasound, chest X-ray and blood samples) and PET/CT with no prior knowledge of the other. RESULTS: PET/CT identified a primary tumor in all but three patients (97%). PET/CT solely detected distant metastases (ovary, bones and lung) in 6 patients and new primary cancers (ovary, lung) in another two patients, as well as 12 cases of extra-axillary lymph node involvement. In 15 patients (15%), extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 14% (14/103) and ultimately a modification of planned treatment in 8% (8/103) of patients. CONCLUSIONS: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative (18)F-fluorodeoxyglucose-PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer with tumors ≥2 cm.

In vitro measurement of the length of the sphincter of Oddi.

A study to determine the length of the sphincter of Oddi was performed using 148 autopsy specimens with adjacent structures obtained from adults. The median diameter of the common bile duct was 7 mm (range 4-13 mm). The median intramural length of the sphincter measured at gross examination of 75 specimens was 14 mm (range 7-22 mm); the median length of the common channel between the common bile and pancreatic ducts was 3 mm (range 0-9 mm). Longitudinal histological preparations for microscopic examination were made of 73 specimens. The median extramural length of the sphincter was 5 mm (range 1-11 mm). No associations were found between the length of the sphincter, intramural or extramural, and the diameter of the common bile duct, age, sex, presence of stones in the gallbladder or the postcholecystectomy state, nor was there an association between the intramural and extramural length of the sphincter (p greater than 0.05).

Gallbladder stones classified by chemical analysis of cholesterol content. Frederiksberg, 1987-1988.

Gallstones from 80 cholecystectomies and 81 autopsies were chemically analysed and showed a trend of decreasing cholesterol content with increasing age (p = 0.00009). The frequency of cholesterol stones (cholesterol content greater than 70%) was higher in operated women (81%) than in operated men (33%) (p = 0.0006) and in the total autopsy material (42%). The study supports the theory that the predominance of gallstone disease in women is an effect of the preponderance of cholesterol stones. The accuracy of estimates of cholesterol content of gallstones from the appearance of the cut surface was low. When the chemical analysis was used as a key, only one in three was correct. There was a tendency to underestimate cholesterol content.

[Acute cholecystitis with and without gallstones. The frequency of surgical interventions in Frederiksberg during the period 1978-1988]. / Akut kolecystit med og uden galdesten. Operationsincidensen på Frederiksberg 1978-1988.

In Frederiksberg Hospital in Denmark the therapeutic procedure for acute cholecystitis requiring operation was altered in 1983. Since then, acute cholecystitis has constituted 15% of all cholecystectomies which corresponds to 15 per 100,000 of the population per annum. 12% of these cases were without stones in the gallbladder. Cases of a calculous cholecystitis do not differ from calculous cases as regards age, sex, clinical history in the month preceding operation and the histological findings.

Prevalence of gallstones at autopsy at the Institutes of Forensic Medicine in Aarhus and Copenhagen, Denmark, in 1944-1985.

The prevalence of gallstones and the post-cholecystectomy state in a material of forensic autopsies was reviewed in five series from 1944-46 to 1985, with a total of 5031 cases. Analysed in a multiple logistic regression program with gallstones and post-cholecystectomy state as response variable, and sex, age, manner of death, and calendar years as explanatory variables, the data showed no interactions, with the exception of the manner of death, which may have a different effect (NS) on the two sexes. The prevalence, which was more than halved from 1954-56 to 1985 (p less than 10(-4], was more than twice as high for women as for men, and it increased with age (p less than 10(-4]. However, the later the calendar period, the less steep the prevalence increase with age. A subdivision in accordance with the cause of death (natural or by accident) showed an association between death-causing disease and gallstones for men (p = 10(-3] but no significant difference for women.

Sphincter of Oddi and filling of the gallbladder. A necropsy study.

The importance of the sphincter of Oddi for the filling of the gallbladder has not been definitely established. It was the aim of this study to establish the extent to which gallbladder filling is affected by the total absence of resistance at the sphincter of Oddi. The external bile ducts were dissected out in 20 autopsies. After elimination of the sphincter of Oddi and division of the cystic duct at the junction to the gallbladder, infusion of water into the common hepatic duct under physiological flow conditions showed that no water passed the spiral valve of the cystic duct. Water flow stopped here in all 20 cases, i.e. 100% (95% confidence limits 83-100). If gallbladder filling is not possible it may be difficult to accomplish non-invasive procedures for the elimination of stones in the gallbladder.

Cholecystectomy rate in autopsies from a Danish urban area. Frederiksberg 1914-1987.

A review of 7,647 autopsies performed in 1914-1987 on 3,629 women and 4,018 men aged 50-79 years in a Danish urban area demonstrated significant increase in the rate of cholecystectomy (p less than 10(-3] for men and women 'at risk', i.e. with stone-containing or removed gallbladder. The rates for men and women were approximately parallel, but with median 10% (range -4%-27%) higher in the women. In 1987 the corresponding rates at autopsies were 37% for women and 21% for men. As cholecystectomy rates are products of multiple variables which may be independent of the individual patient, such figures are a questionable measure of morbidity from gallstones, but so long as cholecystectomy rates rise, the need for treatment cannot have been met.

The prevalence of gallstones in autopsies from a Danish urban area. Frederiksberg 1914-1955.

The prevalence of stone-bearing or absent gallbladder at autopsy was reviewed in five series from 1914 to 1955, with a total of 3,166 cases. The total prevalence rose significantly over the years, from 8 to 29% in men and from 17 to 45% in women, with the increase almost equally distributed in the age groups 50 to 80 years (p less than or equal to 10(-2)). The female:male ratio for prevalence of gallstones/cholecystectomy fell from 3.3 around 1925 to 1.6 in 1955. From these figures, viewed together with findings from 7974 autopsy records from the same area in 1959-1985, which showed a significant fall in gallstone/cholecystectomy prevalence, culmination of this prevalence was estimated to have occurred between 1955 and 1965.

The prevalence of gallstones in autopsies from a Danish urban area. Frederiksberg, 1959-1985.

The prevalence of gallstones and cholecystectomies (S + R) was reviewed in nine annual autopsy series, from 1959 to 1985. The investigation confirmed the expectancy of more S + R with increasing age and among women. The median sex ratio was 1.6 (range, 1.3-1.7). It is noteworthy, however, that although the number of elderly people in the autopsy material increased during the period, there was a significant decrease in the prevalence of S + R (p = 2 X 10(-8]. The total prevalence for men decreased from 26% to 18% (p = 2 X 10(-3] and for women from 44% to 31% (p less than 10(-10]. The most striking decrease was seen in the age groups from 60 to 80 years. After a possible culmination during the period from 1920 to 1960, the number of gallstones seemed to level off again. The rates were the same as at present in other Danish investigations from the Copenhagen area (1889, 1911, and 1920-21).

Cutaneous ureterostomy in cancer patients.

Twenty-four patients with malignant pelvic mass had diverting ureterocutaneostomy. Four patients (17%) developed necrosis and one (4%) required surgical correction due to stenosis. The remaining patients had a well-functioning ureterocutaneostomy until the death which occurred median 174 days later. We find that good palliation can be achieved using this simple operation, and therefore recommend it as the urinary diverting procedure to patients with obstructing pelvic malignancy.

Double common bile duct. Case report and review.

A case of an accessory common bile duct inserting near or on the minor duodenal papilla revealed by ERCP. The patient had no symptoms related to the anomaly. A review of the literature revealed 23 cases from the last 500 years. The accessory bile ducts opened into the gastrointestinal tract at different distances from the major duodenal papilla. In certain animals a double common bile duct is normal. The anomalies are assumed to be caused by random subdivisioning of the hepatic diverticulum early in organogenesis.

Cutaneous eruptions and intrauterine contraceptive copper device.

In the course of 6 months, 1888 intra-uterine contraceptive devices (IUCD) were inserted in a public clinic for contraception. In 10 of the women the IUCD subsequently had to be removed because of skin complaints. Four of these women as well as 3 out-patients of the Department of Dermatology. The Finsen Institute, who had been fitted with an IUCD were tested for metal allergy with closed patch tests and intracutaneous tests. None of the women was allergic to copper. One woman was allergic to nickel, which could be traced in minimal amounts in the copper wire of the IUCD, though causal connection between nickel in the IUCD and the skin symptoms is believed to be unlikely.

PIP: Contact dermatitis to metals, though rare, does occur. This study estimated the practical significance of IUD material in skin disease by conducting tests for metal allergy over a 6-month period in copper IUD-using women with skin reaction complaints; i.e., can internal provocation result in cutaneous allergic reactions? In these 6 months, 1888 IUDs were inserted in a public clinic, all of which were copper-containing devices. Of these 1888 clients, 13 women complained of skin disease. Of these 13, 7 were investigated clinically for skin manifestations and were exposed to a standard patch tests for nickel, cobalt, potassium, and copper sulfate, which was performed as a closed patch test. None of the women showed positive delayed allergic reactions to copper sulfate at 2.5 and 5% in petrolatum. (1 woman showed positive allergic reactions to lanolin and rubber and a toxic reaction to copper sulfate at 5%.) In 6 of the 7 women, the copper IUD was removed because of skin symptoms, and the removal showed certain positive effects on the skin disease, varying from clearing in several days to gradual but incomplete regression. In 4 women, dermatological diagnoses not implicating the copper IUD were established. 1 woman with hand eczema developing after insertion of IUD was allergic to nickel sulfate, of which minimal amounts were present in the IUD's copper wire. However, causal connection between nickel in the copper IUD and skin symptoms is believed unlikely.