Treatment of cancer patients in the Nordic countries

A recent analysis of epidemiological data from the Nordic Cancer Registries revealed that the prognosis of several groups of cancer patients in Denmark is inferior to that of the other countries. These differences have evolved during the last 20-30 years. The prognosis of cancer patients in the Nordic countries is reasonably good compared to other European countries and to the black community in the United States while the white community in the US has a better prognosis with regard to most of the cancer diseases. It is speculated that these differences reflect differences in resources allocated to cancer treatment.     

Intestinal parasites in swine in the Nordic countries: prevalence and geographical distribution

In Denmark (DK), Finland (FIN), Iceland (I), Norway (N), and Sweden (S), 516 swine herds were randomly selected in 1986-1988. Individual faecal analyses (mean: 27.9 per herd) from eight age categories of swine showed that Ascaris suum, Oesophagostomum spp., Isospora suis, and Eimeria spp. were common, while Trichuris suis and Strongyloides ransomi-like eggs occurred sporadically. Large fatteners and gilts were most frequently infected with A. suum with maximum prevalences of 25-35% in DK, N and S, 13% in I and 5% in FIN. With the exception of the remarkably low A. suum prevalence rates in FIN, no clear national differences were observed. Oesophagostomum spp. were most prevalent in adult pigs in the southern regions (21-43% in DK and southern S), less common in the northern regions (4-17% adult pigs infected), and not recorded in I. I. suis was common in piglets in DK, I, and S (20-32%), while < 1% and 5% were infected in N and FIN, respectively. Eimeria spp. had the highest prevalences in adult pigs (max. 9%) without clear geographical differences. I. suis and Eimeria spp. were recorded for the first time in I, and I. suis for the first time in N.     

Sketching the framework for a history and sociology of homosexualities in the Nordic countries

Homosexual acts between women were criminalized in Finland in the 1889 Penal Code which also criminalized men's homosexual acts for the first time explicitly in Finnish legislation. The inclusion of women in the Penal Code took place without much ado. In the article it is argued that the uncomplicated juxtaposing of men and women was due to the legacy of a cultural pattern where man and woman, as categories, were not in an all-pervasive polarity to each other, for example, in sexual subjectivity. A cultural pattern of low gender polarization was typical of preindustrial rural culture, and it can help us apprehend also certain other features in contemporary Finnish social and political life, for example, women obtaining a general franchise and eligibility for the parliament first in the world, in 1906. A modern image of "public man" and "private woman" was only making its way in Finnish society; hence, there was not much anxiety at women's entry in politics, or, for that matter, at their potential for (homo)sexual subjectivity becoming recognized publicly in criminal law.     

Flat-panel digital radiology with amorphous selenium and active-matrix readout

The influence of respiratory activity of the abdominal muscles on their reaction time in a postural task was evaluated. The electromyographic (EMG) onsets of the abdominal muscles and deltoid were evaluated in response to shoulder flexion initiated by a visual stimulus occurring at random throughout the respiratory cycle. Increased activity of the abdominal muscles was produced by inspiratory loading, forced expiration below functional residual capacity, and a static glottis-closed expulsive maneuver. During quiet breathing, the latency between activation of the abdominal muscles and deltoid was not influenced by the respiratory cycle. When respiratory activity of the abdominal muscles increased, the EMG onset of transversus abdominis and internal oblique, relative to deltoid, was significantly earlier for movements beginning in expiration, compared with inspiration [by 97-107 ms (P < 0.01) and 64-90 ms (P < 0.01), respectively]. However, the onset of transversus abdominis EMG was delayed by 31-54 ms (P < 0.01) when movement was performed during a static expulsive effort, compared with quiet respiration. Thus changes occur in early anticipatory contraction of transversus abdominis during respiratory tasks but they cannot be explained simply by existing activation of the motoneuron pool.     

Comprehensive 1-year cost analysis of open antireflux surgery in Nordic countries. Nordic GORD Study Group. Gastro-oesophageal reflux disease

BACKGROUND: Antireflux surgery is a highly effective treatment option in patients with severe gastro-oesophageal reflux disease. However, because of the increasing pressure of cost containment within health care, cost aspects must also be added to the decision-making process. METHODS: The aim of this analysis was to assess the total cost of open antireflux surgery during the first year after operation in 178 patients with chronic reflux, who were recruited into a controlled, prospective clinical trial. The study was carried out in 17 hospitals in the Nordic countries. RESULTS: The cost of the operation represented more than 90 per cent of the direct medical costs which amounted to approximately US $5700. For a patient in the work force the indirect cost, i.e. loss of production, represented 47 per cent of the total cost, which was about US $10800. CONCLUSION: The total cost profile of open antireflux surgery has now been established prospectively and can form a basis for future comparisons.     

Risk of subsequent malignant neoplasms among 1,641 Hodgkin's disease patients diagnosed in childhood and adolescence: a population-based cohort study in the five Nordic countries. Association of the Nordic Cancer Registries and the Nordic Society of Pediatric Hematology and Oncology

PURPOSE: To assess the risk of subsequent malignant neoplasms among Hodgkin's disease patients diagnosed before 20 years of age in the five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). PATIENTS AND METHODS: There were 1,641 Hodgkin's disease patients identified through the national cancer registries since the 1940s or 1950s. The patients were monitored for 17,000 person-years until the end of 1991. Expected figures were derived from the age-specific incidence rates in each country and standardized incidence ratios (SIR) were calculated. RESULTS: A total of 62 subsequent neoplasms were diagnosed (SIR, 7.7; 95% confidence interval [CI], 5.9 to 9.9). The overall cumulative risk of subsequent neoplasms was 1.9% at the 10-year follow-up point, 6.9% at 20 years, and 18% at 30 years. There were 26 subsequent neoplasms among males (SIR, 6.5; 95% CI, 4.3 to 9.6) and 36 among females (SIR, 8.9; 95% CI, 6.2 to 12), of which 16 were breast cancers (SIR, 17; 95% CI, 9.9 to 28). High risks were seen for thyroid cancer (SIR, 33; 95% CI, 15 to 62), for secondary leukemia (SIR, 17; 95% CI, 6.9 to 35), and for non-Hodgkin's lymphoma (SIR, 15; 95% CI, 4.9 to 35). The relative risk increased from 3.3 (95% CI, 1.2 to 7.1) for Hodgkin's disease patients diagnosed in the 1940s and 1950s to 15 (95% CI, 7.4 to 27) in the 1980s. The highest risk of secondary leukemia (SIR, 68; 95% CI, 18 to 174) was seen among those diagnosed with Hodgkin's disease in the 1980s. CONCLUSION: Patients who survive Hodgkin's disease at a young age are at very high relative risk of subsequent malignant neoplasms throughout their lives. In particular, the high relative risk of breast cancer following Hodgkin's disease in the teenage years calls for enhanced activity for early diagnosis.     

Differences in strategies for carcinoma of the pancreas between Japan and western countries

This study defines normative flow velocity (FV) ranges for the common carotid (CCA), internal carotid (ICA) and middle cerebral arteries (MCA), compares them to subjects with nonfocal vascular disease (mild to moderate hypertension, diabetes, hyperlipidemia or coronary artery disease), and clarifies the association between carotid and MCA FVs. FVs were measured by carotid and transcranial Doppler ultrasonography in 278 healthy and 190 vascular-disease subjects. Normative FV ranges for CCA, ICA and MCA were large in healthy subjects, with modest gender and age differences. Vascular-disease subjects had similar FVs to healthy controls. MCA FVs were significantly correlated with carotid FVs (r ranged 0.26-0.50), but were only weakly or not significantly associated with them (beta ranged 0.08-0.18) when controlling for age and gender. These findings suggest that normative FVs are not affected by the presence of nonfocal vascular disease, but carotid FVs do not aid in assessing MCA FVs.     

Increased birth weights in the Nordic countries. A growing proportion of neonates weigh more than four kilos

The proportion of children with high birthweights is increasing in Sweden, as in the other Nordic countries. According to the Swedish national birth registry (founded in 1973), the proportion of term (i.e. (37 gestational weeks) offspring of singelton pregnancies, and weighing four kg or more, increased from 16.9 per cent in 1973 to 20.3 per cent in 1995. The respective figures for the first-born subgroup were 12.9 and 15 per cent, the increase in mean birthweight being from 3400 to 3520 g. There was a corresponding increase in head circumference. The risk of delivery-related complications increases with birthweight over four kg, and a higher incidence of major perineal rupture (grade 3 or 4) has been reported, as well as a disturbing increase in the incidence of brachial plexus damage. Findings in recent studies suggest high birthweight to be associated with an increased risk of subsequent morbidity, both in childhood and in adulthood, specifically diabetes type 1, eczema and certain malignancies, particularly breast cancer and prostate cancer. Although the cause of the increasing proportion of large newborns is not known, it may be partly due to weight increase among gravidae. Another possible explanation is reduced maternal smoking, as smoking is less common now than in the 1970s.     

Image presentation in digital radiology: perspectives on the emerging DICOM display function standard and its application

DICOM (Digital Imaging and Communications in Medicine) Working Group XI, formerly called ACR/NEMA (American College of Radiology/National Electrical Manufacturers' Association) Working Group XI, is currently developing a display function standard. The main objective of the standard is to define mathematically a display function for all image presentation systems. As a secondary objective, the standard aims at providing similarity in gray-scale perception for a given image between display systems of different luminance and at facilitating efficient utilization of the available digital input levels of a display system. The design of the display function incorporates the concept of perceptual linearization. The proposed standard applies to monochrome image presentation devices such as cathode ray tube monitor-display controller systems and digital laser image printers. The standard does not eliminate the use of application-specific display functions but rather ensures their effectiveness. Neither does the standard guarantee equal information transfer between image presentation devices with different physical properties; it does, however, from the basis for applying image processing to compensate for such differences.     

Differences in the p53 gene mutational spectra of prostate cancers between Japan and Western countries

Mutations of the p53 gene are related to development of human cancers and their frequencies and spectra, the latter representing fingerprints left by carcinogens, provide information about the molecular epidemiology of the disease. Prostate cancer is the most common neoplasm in American males and although its incidence is still relatively low in Japanese people, it has recently been increasing with the westernization of life style. To assess the frequency and spectrum of p53 gene mutations in Japanese prostate cancers, we examined a series of 90 lesions using polymerase chain reaction (PCR)-single-strand conformation polymorphism (SSCP) analysis. The patients' mean age was 69.3 years (range 57-87). Of the total, six were well-, 34 moderately- and 50 poorly-differentiated adenocarcinomas, and the median Gleason score was 7.9. Eleven of the 90 cases (12%) had mutations in exons 2-11 of the p53 gene: none of the five clinical-stage A, one of 25 stage B (4%), three of 35 stage C (9%) and seven of 25 stage D (28%) cancers. The correlation with an advanced stage was statistically significant. One insertion and 10 base pair substitutions were encountered, comprising six transversions (55%) and four transitions (36%). Two of the latter involved methylated cytosine-guanine (CpG). These 11 mutations were combined with 18 other mutations in previous reports concerning Japanese prostate cancers to facilitate comparison of the p53 gene mutational spectrum with those reported for American and European prostate cancers. In the latter, 61% were transitions and 33% were transversions. The greater proportion of transversions in the Japanese population suggests that there are different factors responsible for carcinogenesis of the prostate glands in the various countries.     

Web-based digital radiology teaching file: facilitating case input at time of interpretation

OBJECTIVE: Our goal was to develop a software system that allows easy and rapid input of digital radiology images and text reports, at the time of interpretation, into an easily searchable electronic teaching file database using the Internet and the World-Wide Web protocols, servers, and browsers. CONCLUSION: Using the Internet, the World-Wide Web, and our software system, we can rapidly input digital radiology images and associated text reports into an easily searchable database accessed by privileged users. This inexpensive and simple method for building a digital teaching file database allows cross-platform access for users who have a Web browser.     

Creating and curating a pediatric radiology digital library to make the internet a useful reference tool for the radiologist

BACKGROUND AND OBJECTIVE: The endothelial cell count after phacoemulsification serves as a sensitive indicator for the level of corneal damage caused by different phacoemulsification techniques. PATIENTS AND METHODS: In a prospective and randomized study, the "Reversed Tip and Snip" technique and the "Divide and Conquer" technique were performed in groups of 30 patients each. The corneal endothelial cell count was measured preoperatively as well as 4 weeks and 3 months postoperatively. RESULTS: The endothelial cell count showed significant (P < .001) reduction by approximately 10% after the "Reversed Tip and Snip" technique and by approximately 15% (P < .001) after the "Divide and Conquer" technique. The latter produced a significantly (P < .001) greater cell loss. CONCLUSIONS: The "Reversed Tip and Snip" phacoemulsification technique produces less endothelial cell loss than the "Divide and Conquer" technique.     

X-ray imaging using amorphous selenium: feasibility of a flat panel self-scanned detector for digital radiology

We investigate a concept for making a large area, flat-panel detector for digital radiology. It employs an x-ray sensitive photoconductor to convert incident x-radiation to a charge image which is then electronically read out with a large area integrated circuit. The large area integrated circuit, also called an active matrix, consists of a two-dimensional array of thin film transistors (TFTs). The potential advantages of the flat-panel detector for digital radiography include: instantaneous digital radiographs without operator intervention; compact size approaching that of a screen-film cassette and thus compatibility with existing x-ray equipment; high quantum efficiency combined with high resolution. Its potential advantages over the x-ray image intensifier (XRII)/video systems for fluoroscopy include: compactness; geometric accuracy; high resolution, and absence of veiling glare. The feasibility of the detector for digital radiology was investigated using the properties of a particular photoconductor (amorphous selenium) and active matrix array (with cadmium selenide TFTs). The results showed that it can potentially satisfy the detector design requirements for radiography (e.g., chest radiography and mammography). For fluoroscopy, the images can be obtained in real-time but the detector is not quantum noise limited below the mean exposure rate typically used in fluoroscopy. Possible improvements in x-ray sensitivity and noise performance for the application in fluoroscopy are discussed.     

Mortality and morbidity conference in radiology

Triple pelvic osteotomy reorients the acetabulum relative to the pelvis in order to improve acetabular coverage of the femoral head in cases of acetabular dysplasia. We undertook a radiostereometric analysis (RSA) on 6 osteotomized cadaver hips to determine the actual three-dimensional reorientation obtained. The centers of the femoral head were all translated posteriorly between 11 and 41 mm, and distally up to 13 mm. 4 were lateralized up to 8 mm, and 2 were medialized up to 5 mm. All acetabuli rotated anteriorly about the lateral to medial axis (X-axis), and 4 rotated outwards around the distal to proximal axis (Y-axis). The correlations between measurements performed on conventional anteroposterior radiographs and the RSA measurements were poor: variations in the lateral-medial direction ranged from -16 to +6 mm, and in the distal-proximal direction between -10 and +12 mm. The changes in orientations measured will significantly affect the load across the hip joint, since the dimensions of the pelvis change and the moment arms of the muscles, their lengths and lines of action are changed as well. We conclude that, with the procedures presently performed, the loads across the hip joint are bound to change, and that the reorientation can hardly be checked with conventional radiographs.     

Use of Diprivan in radiology

For radiological examinations, propofol is administered, depending on the indications, at following doses: for anxiolysis: i.v. bolus of 10-20 mg, repeated as required; for sedation with maintenance of spontaneous ventilation: i.v. bolus of 0.5 mg.kg-1 or continuous infusion of 3 mg.kg.h-1. for general anaesthesia: i.v. bolus of 2 mg.kg-1 and maintenance with a continuous infusion of 6-10 mg.kg-1.h-1. These doses are modified according to the patient's reactions and painful episodes. In neuroradiology, indications for anaesthesia include vascular explorations, MRI, computerized axial tomography, as well as biopsies of organs and tumors, with the exception of explorations in patients with tight stenoses of the carotid artery. The use of propofol for cardiological explorations is questioned in adults and mainly in children with a congenital cardiopathy. For some authors this agent is contra-indicated, as during induction it decreases, sometimes excessively, the mean arterial pressure.     

Interventional radiology in the acute pediatric abdomen

This article addresses the most common types of interventional procedures performed in the pediatric abdomen. Nonvascular interventions are stressed because they are more common than vascular interventions.     

Interventional radiology in the treatment of pulmonary embolism

Percutaneous therapy of pulmonary embolism is performed by local administration of thrombolytic agents or by mechanical canalization. The latter is achieved by fragmentation of the embolus with angiographic catheters, or by aspiration or fragmentation of the thrombus with dedicated devices. The pharmacologic basis of locoregional administration of thrombolytic agents, as in the treatment of deep vein thrombosis, is the possibility of reaching a higher concentration of the drug at the level of the embolus by decreasing the activity of systemic fibrinolysis, thus lowering the incidence of hemorrhagic complications. In recent years, locoregional thrombolytic therapy has been used only combined with mechanical canalization. The easiest way is direct fragmentation of the embolus with an angiographic catheter. The system of aspiration of pulmonary emboli, experimented by Greenfield is based on the use of a flexible catheter the tip of which is equipped with a plastic radiopaque cup. Recently, several rotating devices have been designed. Some have already been used for the peripheral arterial system, others are specific for the venous system (Schmitz-Rode-Gunther device). The clinical effectiveness of these devices is however still to be assessed. Other non conventional possibilities for the mechanical canalization of pulmonary arterial system are represented by metal stents and angioplasty with balloon catheters. At present, interventional radiologic procedures represent an additional tool in the medical or surgical therapy of severe pulmonary embolism, when it is contraindicated or ineffective.