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Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short-term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S-group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5-day period (RT-group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow-up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S-group and 16 in the RT-group. Fifteen patients in the S-group had pelvic recurrence compared to 10 patients in the RT-group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S-group and 16 months in the RT-group. Postoperative complications in the form of wound sepsis were slightly more common in the RT-group. In summary, the applied treatment regimen, is well-tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy.

Thirty-four patients with gallstone disease were examined with cholescintigraphy and gastroscopy before and after cholecystectomy. Sixteen patients had a functioning and 23 a non-functioning gallbladder at cholescintigraphy. At scintigraphy 99Tcm-activity was found over the gastric fundus in 28% before and in 22% after cholecystectomy and there was no difference between the groups with and without a functioning gallbladder regarding bile reflux. Before cholecystectomy bile-stained contents in the stomach was significantly more often found among those with a non-functioning gallbladder (87%) than in those with a functioning gallbladder (44%). After cholecystectomy the number of patients with bile-stained contents in the stomach was high in both groups (92% and 82% respectively). No correlation could be found between the two methods to detect bile in the stomach. Before cholecystectomy patients with a functioning gallbladder had inflammatory changes in the antral as well as the fundic mucosa in 31%. Patients with a nonfunctioning gallbladder had inflammatory changes in the antral mucosa in 47% and in the fundic mucosa in 56%. These differences were however not statistically significant. No correlation could be found between bile-stained contents in the stomach and chronic gastritis or scintigraphically detected bile in the stomach and chronic gastritis. The degree and distribution of chronic gastritis was virtually unchanged one year after cholecystectomy.

A prospective series of 26 patients with portal hypertension and recent bleeding from esophageal varices was investigated with percutaneous transhepatic selective portography (PTP). PTP was performed immediately prior to and, in 23 patients, just after the initial endoscopic injection sclerotherapy (ST) session to study the acute effects of ST on the mediastinal portal-systemic collaterals. Late follow-up PTP was performed after a median of 8 months in 21 of 26 patients considered endoscopically to be free from esophageal varices after a median of 6 ST sessions. Five patients rebled from esophageal or gastric varices during the follow-up period of 15 months, but there were no fatalities due to variceal hemorrhage. In all patients, the initial PTP showed portal-systemic mediastinal collaterals. Immediately after ST, it was not possible to opacify esophageal varices at all (10 patients) or only partially (7 patients). Five patients died prior to late follow-up PTP. Endoscopic judgment of complete eradication of esophageal varices after repeated ST was in agreement with the late PTP results in 18 of 21 patients. In one patient, PTP showed residual esophageal varices subsequently confirmed by endoscopy. The results were uncertain in two patients for technical reasons. This study supports the opinion that submucosal esophageal varicose veins, as visualized by PTP, can be efficiently eradicated by serial ST, leaving the other mediastinal collaterals unaffected.

The records of 400 patients operated on for primary hyperparathyroidism during 10 years were reviewed. Seventy-three per cent of the patients were women. The mean age at operation was 58 years. Renal stones was the main indication for surgery in 52 per cent of the men, but only in 17 per cent of the women. Forty-four per cent of the women and 22 per cent of the men had neuromuscular symptoms. Fifteen per cent of the patients were asymptomatic. Hypercalcemia was moderate in most cases with mean S-Ca less than 3.0 mmol/l in 80 per cent. A conservative surgical approach with microscopical identification of one or two glands only was used in 2/3 of the cases. Subtotal parathyroidectomy was performed in less than 10 per cent. Single adenoma was found in 70 per cent, double adenomas in 4 per cent, hyperplasia in 17 per cent and cancer in 1 per cent. The outcome of the operation was normocalcemia in 86 per cent. Seven per cent had persistent hypercalcemia. Seven per cent were hypoparathyroid and had to take calcium or vitamin D to be normocalcemic. The frequency of hypoparathyroidism was highest in the group of patients where all four parathyroid glands had been biopsied during the operation. The results support a conservative surgical strategy with careful bilateral exploration without biopsy of all four glands.

The hemorrhagic bone cyst and the latent bone cyst are pathological conditions of unknown etiology occurring in the jaws. Hemorrhagic cysts are diagnosed radiographically and clinically, while latent bone cysts are often diagnosed on radiographical findings alone. In this paper, a case is described where a hemorrhagic bone cyst failed to heal completely after surgery and left a lesion resembling a latent bone cyst. This was probably caused by a defect of the lingual cortical plate first observed during surgical treatment. A tomogram subsequently revealed persistence of this lingual cortical defect. The case suggests that some lesions diagnosed as mandibular latent bone cysts may, in fact, be healing defects associated with pathological lesions having a defective lingual cortical plate.

In a double-blind, controlled, cross-over trial on 10 healthy volunteers, the effects of daily doses of maprotiline (75 mg) and zimelidine (100 mg) over a 14-day period were tested on saliva secretion rate and saliva composition. Based on current knowledge of salivary gland physiology and the difference in specificity between the two drugs, differences in salivary gland response could be expected. Since both drugs have anticholinergic effects which influence saliva secretion rate, the measured component concentrations had to be recalculated with regard to dependencies of secretion rate. Maprotiline, but not zimelidine, caused strong inhibition of secretion rate and accommodation ability. Maprotiline consistently caused around 50% increases in concentrations of the following saliva components: protein, amylase, fucose, hexose, sialic acid and potassium. The effects of zimelidine were less pronounced and resulted in initial increases of most organic components. 14 and 18 h after the intake of the drug these increases had disappeared and some of the components instead showed decreased concentrations. The results are consistent with current theories about facilitated serotoninergic and noradrenergic transmissions during treatment with antidepressants.

All cases of motor neuron disease (MND), encompassing amyotrophic lateral sclerosis (ALS), progressive bulbar paralysis (PBP) and progressive spinal muscular atrophy (PSMA), in northern Sweden, diagnosed between 1969-1980 have been analysed. 128 cases were found, corresponding to an average annual incidence rate of 1.67 per 100,000. The prevalence on December 31, 1980 was 4.8 per 100,000. Age-specific incidence rates were higher in the high age groups with a maximum at 60-64 years for males, at 70-74 years for females and at 65-69 years for the sexes combined. The median age at onset was 61 years. Clustering was not found in mining districts and overrepresentation of miners and stone treaters was not observed. Minor differences in incidence rates, as measured by the standardized morbidity ratio, SMR, were found between the inland, coastal and mountain areas. The median survival time after onset of disease was 32 months for ALS, 30 months for PBP and 70 months for PSMA. The combined survival rate for all MND cases was 28% after 5 years and 15% after 10 years. The male to female ratio was 1.1:1, and 4.7% were familial cases.