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This review states the reasons for considering screening for intracranial aneurysms in Denmark: if patients have two first-degree relatives with intracranial aneurysms, are 30-70 years old, do not have competing disorders, which could significantly shorten life expectancy, and subsequently in patients with autosomal dominant kidney disease and a family history of subarachnoid haemorrhage. MR angiography should be the imaging study of choice, unless contraindicated. Generally, the ethical consequences ought to be considered before carrying out screening.

Peutz-Jeghers syndrome (PJS) is an inherited, autosomal dominant disorder characterised by haematomatous polyps in the gastrointestinal tract and mucocutaneus hyperpigmentation. A girl 15 years of age presented with microcytic, hypochrome anaemia. Endoscopy revealed several polyps in the stomach and colon. The patient was later operated due to an intussusception from polyps in the jejunum. Histology proved the polyps to be haematomatous as seen in PJS. Patients with PJS have an increased risk of developing both gastrointestinal and extra-gastrointestinal cancers. Screening recommendation for PJS is outlined.

Introduction: Gastrointestinal endoscopy in children is a well-established procedure. We reviewed our experience of endoscopy in infants below one year of age to evaluate indications, endoscopic findings, histology, and complications., Material and Methods: Twenty-eight infants were studied over a two-year period. Of these, 18 underwent upper endoscopy, six recto/sigmoidoscopy or colonoscopy, and four both procedures., Results: The most common indication (10/22) for upper endoscopy was vomiting and suspicion of gastrooesophageal reflux disease. In these infants, 24-hour continuous monitoring of the oesophageal pH followed the procedure. Indications for lower endoscopy were rectal bleeding (n = 6) and intractable diarrhoea (n = 4). There were no complications to anaesthesia, endoscopy, or biopsy. Overall, there were endoscopic abnormalities in 82% and histological abnormalities in 75% of the infants. The diagnostic findings included rare disorders, such as eosinophilic gastroenteritis, microvillous inclusion disease, and chylomicron retention disease. Diagnosis of these diseases requires gastrointestinal biopsy., Discussion: Gastrointestinal endoscopy is a safe procedure, which is a valuable part of the diagnostic work-up in a selected group of infants with long-lasting or severe gastrointestinal symptoms.

An 83-year old male with a seminal vesicle abscess is presented. Initially, cancer of the prostate was suspected and the findings of the transrectal ultrasound scan were misinterpreted. The diagnosis was made by CT-scan. When drainage failed the patient was treated successfully with transurethral unroofing.

Experiences with mobile extracorporeal shock wave lithotripsy (ESWL) of urinary calculi using a third generation lithotriptor are reported. A total of 146 renal units in 132 patients received 204 ESWL treatments with mobile lithotriptor for renal and ureteric stones. Treatments were given once a month at Holstebro Hospital and Herning Hospital alternately, with six to eight treatments per day. The overall success was 82% (53% stone-free). Success with renal stones was 89% (51% stone-free) and that with ureteric stones 66% (59% stone-free). Retrograde manipulation appeared to be a safe and effective treatment for patients with obstructing upper ureteric stones. Treatment of other ureteric stones in situ gave unsatisfactory results (success 52%, stone-free 51%). There were no serious complications.

The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.

A case of posttraumatic ischaemic stenosis is presented. The patient, a five year-old girl, was admitted to hospital with physical and radiological signs of small bowel obstruction about two weeks after sustaining blunt abdominal trauma in a car accident. At laparotomy two lesions of the distal jejunum were found. Proximal to this the small intestine was dilated. A segment of 25 cms. of small bowel including the two lesions was resected. Microscopic examination showed two ulcers with adjacent fibrosis consistent with ischaemic stenosis. The patient recovered completely after the operation. The entity of "seat belt syndrome" is presented.

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.

The prognostic value of quantitative histopathological parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous and adenosquamous cell type. Using a projection microscope, estimates were obtained of mean nuclear volume (vV(nuc)), mean nuclear profile area, nuclear profile density, nuclear volume fraction, and mitotic profile frequency. Patient sex, age, and clinical stage was recorded. Single-factor analyses showed a prognostic significance of clinical stage and patient age (2p < or = 0.03), whereas sex was marginally significant (2p = 0.09). Of the quantitative histopathological parameters only estimates of vV(nuc) were of prognostic significance (2p = 0.02), in that small nuclear volumes were associated with the worst prognosis. In a multivariate Cox analysis, clinical stage, age, and vV(nuc) were found to be of significant, independent prognostic value. Thus, the present study indicates that vV(nuc) is of prognostic value, independent of clinical stage. The parameter is highly reproducible and easily obtained using unbiased stereology, and may be of future importance in the management of lung cancer patients.

The aim of the study was to evaluate 1 1/2 hours of lessons on contraception given to 9. and 10. grade students at the Contraception Clinic in Odense, Denmark. The lessons are a supplement to the traditional sexual education given at the school. The study included 148 pupils in the period from August 1991 to January 1992. The median age was 15 years for both girls and boys. The pupils answered two identical questionnaires; one just before the lessons were given and the other ten to 13 weeks after the visit to the clinic. The article presents the answers given about male and female sexual function, knowledge/own choice of contraception, pregnancy, abortion and HIV. The extra lessons improved the knowledge among the pupils, but there were still some boys with inadequate knowledge. The article gives suggestions for improving the teaching of contraception, such as having both male and female teachers. This would also emphasize that both sexes have a common responsibility. If the pupils answer a simple questionnaire before the lessons, it is possible to goal-direct the education to individual requirements. The pupils are introduced to the Contraception Clinic, where they easily can seek advice in the future.

On the basis of a questionnaire investigation among the general practitioners in the County of Frederiksborg, the authors have compared the information given to women applying for sterilization with information in the available literature about the nature of the intervention, its sequelae and the risks involved. The authors found that under half of the practitioners gave informations about disturbances of menstruation, dyspareunia and altered sexual life. In the literature, it is stated that these occur in 10-60%, 3-11% and 4-48% of the women. Less than one third of the practitioners gave information about the risk of perforation of an organ or vessels, tearing of the ovarian tubes and postoperative pain. In the literature, it is stated that these occur in 0.1-2.5%, 0.28-9% and 24% of the women depending on the operative method used. The authors recommend revision of our knowledge on these subjects and alterations in the written information provided.

Four cases of unwanted pregnancy occurring in the same cycle as removal of an IUD are presented. The duration of ovum transport from the Fallopian tube into the uterine cavity, survival of spermatozoa in the female genital tract and timing of ovulation, which may be delayed in women with IUDs are variables which influence the probability of pregnancy and should be taken into consideration when removing an IUD. Unless pregnancy is desired, it is recommended when possible not to remove an IUD after the ninth day of the menstrual cycle unless another contraceptive method has been initiated.

Seventy Uebe's mercury neonatal thermometers were checked in a thermostatically-controlled water bath to detect possible errors in measurement. Sixteen out of 18 old neonatal thermometers showed gross errors of measurement with a maximal deviation of +5.31 degrees C. Out of 52 recently issued neonatal thermometers, only 27 (52%) fulfilled the requirements for correction of maximally 0.10 degree C established by the Danish Ministry of Health. The remaining 25 neonatal thermometers presented lesser errors with a maximal deviation of -0.30 degrees C. Employment of Uebe's mercury neonatal thermometer can thus only be recommended after meticulous testing of the thermometers prior to use and with continued regular control of the accuracy of temperature measurements.

A review is presented of 62 Whipple's resections between 1962 and 1984 for adenocarcinoma of the choledocho-duodenal junction (CDJ) and pancreatic head (PH). The operation was radical in 17 patients with CDJ (94%) and in 34 patients with PH cancer (77%). The cumulative 5-year survival rates were 22% and 9%, respectively. The overall perioperative mortality was 23%, but was lowered to 11% during the last five years. Histology, size of tumour and age also influenced survival. Sixteen of the 32 radically operated patients who survived more than three months had a period without pain. Whipple's resection is still the only hope for cure in otherwise fit patients with CDJ or PH cancer, estimated to be radically resectable by pre- and peroperative investigations. The operation should be centralized in a few departments.