Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction.

BACKGROUND AND AIMS: Longterm survival after curative resection for adenocarcinoma at the gastro-esophageal junction (GEJ) range between 18% and 50%. In the pivotal Intergroup-0116 Phase III trial by Macdonald et all, adjuvant chemoradiotherapy improved both disease-free and overall survival in curatively resected patients with mainly gastric adenocarcinoma. We compared survival data for curatively resected patients with adeno-carcinoma solely at the gastro-esophageal junction (GEJ), treated with surgery alone or surgery and adjuvant chemoradio-therapy. METHODS: From 2003 to 2009, 211 patients underwent curative resection. Surgery alone was performed in 95 pa-tients and 116 patients received adjuvant therapy after resection. All patients underwent Lewis-Tanner operation with D1 node resection including coliac nodes (D1+). Informations about recurrence and death were collected from the Danish Cancer Register and the Central Death Register. Patients who died after experiencing severe complications after surgery were excluded from the survival analysis. Patients with T0N0 or T1N0 were also excluded because patients of this category were not given adjuvant therapy according to the Macdonald protocol. RESULTS: Patients with positive node status in the resected specimen, the 3-year disease-free survival after adjuvant chemoradiotherapy (n = 91) or surgery alone (n = 43) was 24% and 37%, respectively. Median time of survival was prolonged by 10 month in favour of those who received chemoradiotherapy. However, after controlling for the confounding effect of age and node status, only positive node status in the resected specimen had significant partial effect on survival. CONCLUSION: Chemoradiotherapy according to the Intergroup-0116 protocol might still be a reasonable option after curative resection in patients with GEJ adenocarcinomas and positive lymph node status, who did not receive neoadjuvant chemotherapy.

Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study.

OBJECTIVES: To assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct stones in the preoperative investigation of patients electively referred for gallstone disease, to find out the incidence of asymptomatic common duct stones, and to correlate clinical symptoms and history and liver function tests (LFT) with the actual occurrence of common duct stones. DESIGN: Prospective study. SETTING: General hospital, Denmark. PATIENTS: 180 consecutive non-jaundiced patients referred with symptomatic gallstones for elective cholecystectomy. INTERVENTIONS: LFT, abdominal ultrasonography, MRCP, endoscopic retrograde cholangiopancreatography (ERCP), questionnaire. MAIN OUTCOME MEASURES: Positive and negative predictive values and accuracy of MRCP, number of patients with asymptomatic stones, and correlation of symptoms with the presence of stones. RESULTS: 26/180 patients had common duct stones (14%). Only one (<1%) had an asymptomatic stone. For detection of such stones, MRCP's positive predictive value was 0.95 (95% confidence interval (CI): 0.86 to 1.00), negative predictive value 0.96 (0.93 to 0.99), and accuracy 0.85 (0.93 to 0.99). MRCP missed 5 stones 1-4 mm in size in 5 patients; 17/64 patients with raised LFTs had stones (27%). The probability of stones was highest when the patients had both raised LFTs and a dilated common (>7 mm) bile duct (82%). There were no readmissions with ductal stones in the 6-month postoperative period. CONCLUSIONS: The predicive values of MRCP were fairly good, but MRCP misses some small stones <5 mm in size. Asymptomatic stones in the common duct are not common in this population and should not be screened for. The probability of stones increases with the number of predictive factors. Patients should be questioned carefully about signs of biliary obstruction, and only be offered preoperative MRCP should they have a suspicious history, raised LFTs, or a dilated common duct.

[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.

Papillary transitional cell tumour in the vagina.

A case of non-invasive transitional cell tumours in the vagina in a 62-year-old woman is presented. Earlier, the patient had a left nephroureterectomy and a cystectomy performed due to invasive transitional cell tumours. The tumours in the vagina were located in an otherwise normal stratified squamous epithelium.

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.

Paget's disease in a squamous metaplasia of the urinary bladder. The first published case of a disease which is usually found in the epidermis.

Extramammary Paget's disease is usually found in epidermis and is often associated with malignancy in visceral organs. We report the first case with Paget's disease developed in metaplastic squamous epithelium in the urinary bladder.

Clinical behavior of 21st-century adhesives and composites.

The clinical behavior of future adhesives and composite materials for dental restorations will be significantly improved from the performance of today's restorative materials. The adhesives and composites available to the practicing dentists in 10 years will be designed and developed as preventive resin restorations. They will consist largely of adhesive-sealant and composite resin combinations. The new restoratives will be developed in response to early detection of caries, resulting in smaller lesions, and smaller restored surfaces exposed to the oral cavity. There will be less margin length, less vulnerability to wear, and less microleakage. The materials of the 21st century will be less technique sensitive in the hands of the clinician and therefore will result in fewer clinical failures. The advent of better wetting and better bonding adhesives to both enamel and dentin, combined with nonshrinking dental resins that are durable, esthetic, and biocompatible, will significantly improve available dental health care. The clinical behavior of these 21st-century materials should provide longer wearing, nonleaking, esthetic restorations that are easily manipulated and placed by clinicians at an economical cost to dental patients.

Quality of fixed prosthodontics after 15 years.

Interviews and/or clinical examinations by means of the California Dental Association quality evaluation system were carried out in a group of persons who had received extensive restorative treatments with fixed partial dentures 15 years before this study. The studied group consisted of 77 persons who agreed to participate from an original group of 150 persons selected at random from the Swedish Dental Insurance System records. Of the original group 20 had died, 17 were not traceable or not able to participate for medical reasons, and 36 declined to participate. Thirty-two per cent of the recorded reconstructions had been lost, and 8% partially lost during the 15-year period. Thirty-five per cent of the reconstructions were rated as Satisfactory, whereas the remaining ones had mixed clinical quality ratings. Failures and Not Acceptable quality ratings were found to be caused mainly by fractures, loss of retention, and/or dental caries.

[Early complications of enterostomy. Importance of the type of suture]. / Tidlige komplikationer ved anlaeggelse af enterostomi. Betydning af den anvendte suturtype.

The frequency and character of early complications following creation of enterostomies, and their relation to the type of suture material used were studied in 50 consecutive patients. The stomas were matured by muco-cutaneous eversion, and were fixated with Maxon 4-0 and Vicryl 3-0 sutures. Half the stoma circumference was sutured with the one suture type, and the other half with the other. No statistically significant correlation was found between enterostomy type or surgical procedure and complications. The incidence of muco-cutaneous complications was significantly higher following fixation with Vicryl as compared to Maxon sutures. The cause of this difference is uncertain, however, the physical configuration of the sutures seems important, Maxin being monofile versus Vicryl being braided. Whether the chemical structure is significant as well remains undetermined at present.

Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry.

The annual review of selected dental literature this year cites 384 published papers and reports. This year's review contains more editorial comment than reviews of years passed. New data on the biological responses to materials is emphasized in several sections. Observations on new compounds able to prevent plaque formation are presented. Clinically relevant advances in knowledge concerning the etching of different tooth structures are reported along with the effect of etching procedures on the dental pulp. Evaluation of periodontal diseases in all age groups is a topic. Limitations of current diagnostic techniques in periodontal disease, temporomandibular disorders, and implant therapy are included. There are new views on the use of dental amalgam. The future use of dental mercury is predicted. Interest in new ceramic systems is indicated as the demand for esthetics continues. Clinical information is emphasized over scientific information throughout this year's review.

Early local stoma complications in relation to the applied suture material: comparison between monofilament and multifilament sutures.

The frequency and character of early complications following creation of enterostomies, and their relation to the applied suture material, were studied in 50 consecutive patients. The stomas were matured by mucocutaneous eversion and were fixated with Maxon (Davis & Geck, Pearl River, NY) 4-0 and Vicryl (Ethicon, Inc., Somerville, NJ) 3-0 sutures. Half of the stoma circumference was sutured with one suture type, and vice versa. Three patients died within 10 days. Of the remaining 47 patients, 34 (72 percent) had one or more complications diagnosed. Four (9 percent) suffered major complications (one total stoma loosening and three partial stoma necroses), and 30 (64 percent) had mucocutaneous affections only. There was no statistically significant correlation between enterostomy type or surgical procedure and complications, whereas the incidence of mucocutaneous complications was significantly higher following fixation with Vicryl as compared with Maxon sutures. The cause of this difference is uncertain; however, the physical configuration of the sutures, Maxon being monofile vs. Vicryl being braided, seems important. Whether the chemical structure is significant as well remains undetermined at present.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry.

The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.

[Prognosis of surgery performed in premature infants with birth weights below 1500 gram]. / Prognosen ved operativt indgreb hos praemature mindre end 1.500 gram.

On account of improved management in neonatal intensive care units, the survival rate is presently nearly 50% in babies with birth weights below 1,000 grams and 80% in the group with birth weights from 1,000 to 1,500 grams. A number of these babies require surgery, either for correction of congenital anomalies or for acquired necrotizing enterocolitis, which is an increasing burden in neonatal units. The present analysis of 24 babies weighing under 1,500 grams, operated on in the period 1981 to 1988 confirms that even extremely small babies tolerate the performed anesthesia and surgery well. In the group with anomalies (7 of 24) three died (43%). The causes of death do not appear to be related to the anesthesia or surgery. In the group with necrotizing enterocolitis (15 of 24) six died (40%). The cause of death was directly related to the septic condition in all cases, and the surgical trauma does not appear to have any negative influence. Unfavourable prognostic factors in this group were low Apgar scores within the first minute and preoperative weight loss.