Jubileumskliniken Cancerfond

Patients with midgut carcinoids undergoing surgical resection or ischemic treatment of hepatic metastases by embolization are at risk for development of carcinoid crises due to release of hormonally active tumor products. Eight such patients were treated on nine separate occasions with increasing subcutaneous doses of a synthetic somatostatin analogue (SMS 201–995) 4 days prior to surgery or hepatic arterial embolization. The patients were tested by pentagastrin provocation and simultaneous measurement of serotonin (5-HT) levels in peripheral blood before and after prophylactic treatment, to evaluate the efficacy of SMS 201–995. The provoked release of 5-HT was markedly diminished, and the basal levels of 5-HT were markedly reduced in patients with high initial levels. During surgery or embolization both SMS 201–995, as well as ketanserin, a 5-HT2 receptor blacker, were given. With this combined treatment all patients were hemodynamically stable during surgery or embolization. During embolization the arterial levels of 5-HT increased only moderately, while urinary excretion of 5-hydroxyindoleacetic acid remained un-changed despite a proven adequate embolization. Two patients were operated on without previous treatment with SMS 201–995; both developed severe crises at induction of anesthesia, hut IV SMS 201–995 rapidly reversed the bronchoconstriction and facial flush and gradually restored arterial blood pressure, even though cardiac output remained depressed for a prolonged period. The crisis reaction correlated well with high circulating levels of 5-HT, but after treatment with SMS 201–995 these levels were still high. These findings indicate that the acute IV administration of SMS 201–995 can antagonize the peripheral actions of 5-HT and tachykinins, an effect different from the reduced release seen after prophylactic treatment with SMS 201–995. SMS 201–995 may block an intracellular mechanism common for activation of monoamine and tachykinin receptors on both tumor cells and normal cells, which would explain the observed effects. The prophylactic use of SMS 201–995 is recommended prior to surgery or hepatic arterial embolization in patients with disseminated midgut carcinoid tumors, because peripheral blockade of 5-HT, receptors alone is not sufficient to prevent a crisis reaction.

A modified Co/sup 60/ applicator embodying the same fundamental principles as the Stallard-applicators for the treatment of retinoblastoma is described. Five cases are reported. (auth)

Purpose: To compare inflammatory response, visual acuity, and complications of two intraocular lenses (IOLs) in patients with and without uveitis. Setting: Tertiary referral centre at Sahlgrenska University Hospital/Mölndal, Sweden. Design: Prospective randomised controlled trial. Patients and Methods: Patients with and without uveitis eligible for cataract surgery were randomised to receive a hydrophobic or a hydrophilic square-edged intraocular lens (IOL). Patients undergoing bilateral surgery received a hydrophobic IOL in one eye and a hydrophilic in the other. Visual acuity, flare, and central foveal thickness were used as outcome measures. Results: In total, 34 (61%) patients (52 eyes) with uveitis and 22 (39%) non-uveitic patients (38 eyes) were included in the study. Comparable corrected distance visual acuity (CDVA) was seen, regardless of IOL material. Flare, six months postoperatively, for those undergoing bilateral surgery, showed no significant difference between eyes receiving a hydrophilic IOL or a hydrophobic IOL; mean difference was − 3.2 (SD ± 20.7) ph/ms between eyes with uveitis (p = 0.53) and − 0.6 SD ± 7.5 ph/ms between eyes without uveitis (p = 0.77). No significant difference in cystoid macular edema (CME) was seen for uveitic patients receiving a hydrophobic IOL (n = 2; 8.0%) and those receiving a hydrophilic IOL (n = 6; 22.2%; p = 0.25). Conclusion: No significant differences in postoperative inflammatory reaction or rate of CME were seen regardless of using a hydrophobic or a hydrophilic IOL. In general, an improvement in CDVA was seen after cataract surgery with both types of IOLs. Thus, the present study did not support either of the IOL materials as advantageous in patients with uveitis. Plain Language Summary: Uveitis, an inflammatory eye condition, often leads to patients needing cataract surgery. The surgery involves removing the eye’s clouded lens and typically replacing it with an artificial lens known as an intraocular lens. Improvement in vision and possible complications vary depending on the type of replacement lens used. This randomised controlled trial compares inflammation, improvement in vision, and possible complications in patients that received two differing types of intraocular lenses. Improvement in vision was seen in both lens types yet neither lens type was superior in terms of inflammation. Keywords: biocompatibility, cataract, complications, implant, inflammation

Background Shoulder pathology in adult tennis players including rotator cuff pathology is well known. However, early adaptations have not previously been studied in the adolescent elite tennis players. Objectives To describe magnetic resonance imaging (MRI) findings in the shoulder in asymptomatic elite adolescent tennis players. Design A MRI scan using a 3 Tesla scanner of both shoulders were performed. PD (proton density) weighted images with fat-saturation in oblique coronal, oblique sagittal and axial planes together with oblique sagittal T2 images were reviewed especially for the presence of abnormalities regarding labral lesions and rotator-cuff lesions by two radiologists in consensus. The MRI scans were evaluated by to independent experienced radiologists in a blinded manner according to a pre-defined protocol. Data were collected retrospectively for the dominant arm and contralateral arm respectively. Statistical analyses were performed using SPSS software. Setting Testing environment at Medical Rontgen, Sweden. Participants 35 adolescent elite tennis players from the Swedish national team were selected (ages 13–24 years median age 17). 15 boys and 20 girls participated in the study. Intervention Findings were described according to a predefined protocol. Main outcome measurements MRI findings of the dominant and non-dominant shoulder. Results 19 players (54%) had a normal MRI examination and 16 players (46%) had abnormal findings of which 14 players showed affected tendons/tendinosis. The predominant findings were made in infraspinatus (n=10), Supraspinatus (n=5) and Subscapularis (n=1). Two players had findings in both infra- and supraspinatus. Conclusions This is the first study describing MRI findings in adolescent elite tennis players, revealing infraspinatus and supraspinatus affected tendons/tendinosis in this asymptomatic overhead athletic population. The results can serve as the baseline for a future prospective longitudinal cohort study.

Electrochemotherapy is a simple and effective treatment of skin metastases. Electrochemotherapy is possible after previous surgery, radiotherapy and/or limb perfusion. Electrochemotherapy is most likely an under-used treatment modality in Sweden.