Background. Herpes simplex encephalitis (HSE) is a devastating disease. Methods. In Sweden, a nationwide retrospective study of the incidence, morbidity, and mortality associated with HSE during the ...12-year period 1990–2001 was conducted. The national inpatient register data were used, and diagnostic data from the virus laboratories were validated. Results. In the study period, 638 patients hospitalized in Sweden received a primary diagnosis of HSE. Of these, 236 patients had a confirmed infection of the central nervous system due to herpes simplex virus type 1. This corresponds to an incidence of confirmed HSE due to herpes simplex virus type 1 of 2.2 cases per million population per year. Of the survivors, 87% were readmitted to the hospital. The most frequent diagnosis at readmission was epilepsy, which was found in 49 patients (21% of the 236 total patients; 24% of 203 survivors), with a median onset 9.3 months after the diagnosis of HSE. This corresponds to a 60- to 90-fold increase in risk, compared with that for the general population. Neuropsychiatric sequelae were evident in 45 (22%) of 203 surviving patients. The incidence of venous thromboembolism, including pulmonary embolism, was 5–14 times higher than that in the general population. Among patients with HSE due to herpes simplex virus type 1, the 1-year mortality was 14% (33 of 236 patients died), which was 8 times higher than expected. Conclusions. This is, to our knowledge, the first study to report long-term, nationwide follow-up data for patients with virologically confirmed HSE. There is considerable morbidity after HSE, with epilepsy being the most common diagnosis. This demonstrates the need for expanding our knowledge of the pathogenesis of HSE to direct more effective antiviral and antiinflammatory treatments.
Background
Radiation-associated angiosarcoma of the breast (RAASB) is an aggressive malignancy that is increasing in incidence. Only a few previous population-based studies have reported the results ...of RAASB treatment.
Methods
A search for RAASB patients was carried out in the Finnish Cancer Registry, and treatment data were collected to identify prognostic factors for survival.
Results
Overall, 50 RAASB patients were identified. The median follow-up time was 5.4 years (range 0.4–15.6), and the 5-year overall survival rate was 69%. Forty-seven (94%) patients were operated on with curative intent. Among these patients, the 5-year local recurrence-free survival, distant recurrence-free survival, and overall survival rates were 62%, 75%, and 74%, respectively. A larger planned surgical margin was associated with improved survival.
Conclusions
We found that the majority of RAASB patients were eligible for radical surgical management in this population-based analysis. With radical surgery, the prognosis is relatively good.
While treatment for breast cancer has been refined and overall survival has improved, there is concern that the incidence of brain metastases has increased.
We identified patients in Sweden with ...incident breast cancer 1998-2006 in the National Cancer Register, and matched these to the National Patient Register to obtain information on hospital admissions for distant metastases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed with Cox regression as estimates of relative risk.
Among 50 528 breast cancer patients, 696 (1.4%) were admitted with brain metastases during median 3.5 years of follow-up. Admissions for other metastases were found in 3470 (6.9%) patients. Compared with the period 1998-2000, patients diagnosed with breast cancer 2004-2006 were at a 44% increased risk of being admitted with brain metastases (HR 1.44, 95% CI 1.13-1.85).
The incidence of admissions with brain metastases in breast cancer patients was increasing in the mid-2000s in Sweden. These findings support a true increase in incidence of brain metastases among breast cancer patients.
Brain metastases (BM) constitute the most common intracranial tumours and are associated with considerable morbidity and mortality. Population-based studies of the epidemiology and time trends of BM ...are scarce.
A population-based cohort of patients admitted to hospital with BM in Sweden between 1987 and 2006 (n=15,517) was identified and linked to nationwide registers of cancer incidence and death. Primary cancer types were assessed and time to hospitalisation and death was computed.
The annual age-adjusted incidence rate of hospitalisation for BM doubled from 7 to 14 patients per 100,000 between 1987 and 2006. The most common primary tumours among women were lung (33%), breast (33%) and colorectal cancer (7%), and among men lung cancer (44%), malignant melanoma (12%) and colorectal cancer (9%). The increase was most evident for BM patients with lung cancer (both sexes) and breast cancer (women). Survival was short, with a median of 2.7 months. It varied little by cancer type and did not improve over calendar time.
The number of patients admitted with BM has increased rapidly in Sweden. In spite of recent improvements in the prognosis of common primary cancer types, any parallel improvement among patients with advanced cancer and BM is not indicated.
Aliment Pharmacol Ther 2011; 34: 675–681
Summary
Background Colon cancer and diverticular disease are most common in the Western world and their incidences tend to increase with advancing age. The ...association between the diseases remains unclear.
Aim To analyse the risk of colon cancer after hospitalisation for diverticular disease.
Methods Nationwide case–control study. A total of 41 037 patients with colon cancer during 1992–2006, identified from the Swedish Cancer Register were included. Each case was matched with two control subjects. From the Swedish Inpatient Register, cases and control subjects hospitalised for diverticular disease were identified. Odds ratios (OR) and confidence intervals for receiving a diagnosis of colon cancer after hospital discharge for diverticular disease were calculated. Colon cancer mortality was compared between patients with or without diverticular disease.
Results Within 6 months after an admission due to diverticular disease, OR of having a colon cancer diagnosis were up to 31.49 (19.00–52.21). After 12 months, there was no increased risk. The number of discharges for diverticular disease did not affect the risk. Colon cancer mortality did not differ between patients with and without diverticular disease.
Conclusions Diverticular disease does not increase the risk of colon cancer in the long term, and a history of diverticular disease does not affect colon cancer mortality. The increased risk of colon cancer within the first 12 months after diagnosing diverticular disease is most likely due to surveillance and misclassification. Examination of the colon should be recommended after a primary episode of symptomatic diverticular disease.
We present an overview of the critical issues of current interest in magnetic and magnetoelectronic materials. A broad demonstration of the successful blend of materials synthesis, microstructural ...evolution and control, new physics and novel applications that is central to research in this field is presented. The critical role of size, especially at the nanometer length scale, dimensionality, as it pertains to thin films and interfaces, and the overall microstructure, in determining a range of fundamental properties and potential applications, is emphasized. Even though the article is broad in scope, examples are drawn mainly from our recent work in magnetic nanoparticles and core-shell structures, exchange, proximity and interface effects in thin film heterostructures, and dilute magnetic dielectrics, a new class of materials for spin electronics applications.
Radiation‐associated sarcoma (RAS) is a rare complication of radiation therapy (RT) to breast cancer (BC). This study explored RAS after RT to BC in a nationwide population‐based material. The ...Finnish Cancer Registry was queried for patients with BC treated during 1953‐2014 who were later diagnosed with a secondary sarcoma in 1953‐2014. Registry data, patient files, and sarcoma specimens were analyzed to confirm diagnosis and location of RAS at or close to the RT target volume. A total of 132 512 patients were diagnosed with invasive BC during the study period. A subsequent sarcoma was diagnosed in 355 patients. After exclusion, 96 RAS were identified. Angiosarcoma (AS) was the most prevalent histology in 50 (52%) of 96 patients. However, the first radiation‐associated AS was diagnosed in a patient treated for BC with breast‐conserving surgery in 1984, and thereafter, the proportion of AS continuously increased. The 5‐year sarcoma‐specific survival was 75.1% for RAS treated with a curative intent. The distribution of histologic subtypes of RAS has changed during the 60 years of this registry study. The first radiation‐associated AS was diagnosed in 1989, and presently, AS is the most common histologic subtype of RAS. It is possible that changes in BC treatment strategies are influencing the characteristics of RAS.
Angiosarcoma comprises a growing proportion of in‐field radiation‐associated soft tissue sarcomas after breast‐conserving surgery. Patients with radiation‐associated angiosarcoma amenable for mastectomy with clear margin have good survival rates.
Background and purpose - Soft-tissue sarcoma (STS) is rare, with challenging individualized treatment, so diagnostics and treatment should be centralized. Historical controls are sometimes used for ...investigation of whether new diagnostic or therapeutic tools affect patient outcome. However, as yet unknown factors may affect the outcome. We investigated prognostic factors and prognosis in 2 nationwide cohorts of patients diagnosed with a local STS during the periods 1998-2001 and 2005-2010, with special interest in finding factors lying behind possible improvement of prognosis.
Patients and methods - 2 cohorts of patients with STS of the extremities or trunk diagnosed during the periods 1998-2001 and 2005-2010 were retrieved from the nationwide Finnish Cancer Registry. Detailed information was gathered from patient files.
Results - Compared to first cohort, a larger proportion of patients with inadequate surgery in the second cohort received radiation therapy, and both the local control rate and the sarcoma-specific survival rate improved in the second cohort. For sarcoma-specific survival, cohort (HR =0.6, 95% CI: 0.5-0.9), age, depth, grade, and margin were significant factors in multivariate analysis. For local control, cohort (HR =0.6, 95% CI: 0.5-0.9), age, and margin were significant in multivariate analysis.
Interpretation - Known prognostic factors including type of treatment did not entirely explain the secular trend of continuous improvement in prognosis in STS. This illustrates the danger of using historical controls for investigation of whether new diagnostic or therapeutic tools have an effect on patient outcome.
To study mortality after appendectomy.
The management of patients with suspected appendicitis remains controversial, with advocates of early surgery as well as of expectant management. Mortality is ...not known.
The authors conducted a complete follow-up of deaths within 30 days after all appendectomies in Sweden (population 8.9 million) during the years 1987 to 1996 (n = 117,424) by register linkage. The case fatality rate (CFR) and the standardized mortality ratio (SMR) were analyzed by discharge diagnosis.
The CFR was 2.44 per 1,000 appendectomies. It was strongly related to age (0.31 per 1,000 appendectomies at 0-9 years of age, decreasing to 0.07 at 20-29 years, and reaching 164 among nonagenarians) and diagnosis at surgery (0.8 per 1,000 appendectomies after nonperforated appendicitis, 5.1 after perforated appendicitis, 1.9 after appendectomies for nonsurgical abdominal pain, and 10.0 for those with other diagnoses). The SMR showed a sevenfold excess rate of deaths after appendectomy compared with the general population. The relation to age was less marked (SMR of 44.4 at 0-9 years, decreasing to 2.4 in patients aged 20-29 years. and reaching 8.1 in nonagenarians). The SMR was doubled after perforation compared with nonperforated appendicitis (6.5 and 3.5, respectively). Nonsurgical abdominal pain and other diagnoses were associated with a high excess rate of deaths (9.1 and 14.9, respectively). The most common causes of deaths were appendicitis, ischemic heart diseases and tumors, followed by gastrointestinal diseases.
The CFR after appendectomy is high in elderly patients. The excess rate of death for patients with nonperforated appendicitis and nonsurgical abdominal pain suggests that the deaths may partly be caused by the surgical trauma. Increased diagnostic efforts rather than urgent appendectomy are therefore warranted among frail patients with an equivocal diagnosis of appendicitis.
Re-operation rates in spinal stenosis surgery vary between 5 and 23%. Most previous studies have been based on selected patients groups. We analysed the 10-year lumbar spinal stenosis re-operation ...rate from comprehensive Swedish national data during 1987-1999. The mean length of stay decreased from 2 weeks in 1987 to 1 week in 1999. Of 9,664 patients, 628 (6.5%) were re-operated. Within 30 days after the first spinal stenosis operation, 0.15% of the patients were re-operated. The 1-, 2-, 5-, and 10-year re-operation rates were 2, 5, 8 and 11%, respectively. The rate lowered by 31% over time. Adding a fusion may lower the re-operation risk, an observation which can only be evaluated in randomised trial.
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