Long-term, intermittent treatment of chronic hand eczema with mometasone furoate

Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long-term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, chi2-test). Side-effects were minimal. It is concluded that long-term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.

Ovarian stimulation and borderline ovarian tumors: a case-control study

OBJECTIVE

To assess the risk of borderline ovarian cancer among infertile women treated with fertility drugs.

DESIGN

Case-control study.

SETTING

Nationwide data obtained from public registers and postal questionnaires.

PATIENT(S)

All Danish women <60 years old with borderline ovarian cancer during the period 1989-1994 and randomly selected population controls. The analysis included 231 cases and 1,721 controls.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Influence of parity, infertility, and fertility drugs on the risk of borderline ovarian cancer after multivariate confounder control.

RESULT(S)

The odds ratio (OR) for borderline ovarian cancer among infertile untreated nulliparous women compared with fertile nulliparous women was 1.9. The OR for borderline ovarian cancer among treated nulliparous women compared with untreated infertile nulliparous women was 1.5, and the OR among treated parous women compared with untreated infertile parous women was 1.5.

CONCLUSION(S)

Among fertile women, the difference in the risk of borderline ovarian cancer between nulliparous women and parous women was not statistically significant. Nulliparous women who were infertile and who did not receive medical treatment had a twofold higher risk of borderline ovarian cancer than fertile nulliparous women. There was no statistically significant increase in the risk of borderline ovarian cancer among nulliparous women who were treated with fertility drugs compared with nulliparous untreated infertile women or among parous women who were treated with fertility drugs compared with parous untreated infertile women.

Sarcoidosis and cancer revisited: a long-term follow-up study of 555 Danish sarcoidosis patients

For more than 20 yrs it has been debated whether the systemic disease sarcoidosis predisposes to malignant neoplasms. The aim of this study was to examine the occurrence of cancer in Danish sarcoidosis patients observed for 9-30 yrs. The clinical data of 555 consecutive sarcoidosis patients were linked with the nationwide Danish Cancer Registry in a database, comparing the results with the expected incidence in the Danish population, adjusted for sex, age and calendar time. The sarcoidosis patients were diagnosed in two areas during the periods of 1960-1971 and 1970-1981, respectively, and followed until December 31, 1991. No excess of cancer was observed in sarcoidosis patients. A total number of 48 patients were observed with cancer (20 males and 28 females). Cancer occurred 1-29 yrs after sarcoidosis diagnosis (median 14 yrs) The observed versus expected (O/E) ratio was 1.16 (95% confidence interval (CI) 0.75-1.79) in males and 1.28 (95% CI 0.88-1.86) in females. No increased occurrence of lung cancer or malignant lymphoma (O/E ratios 0.23, 95% CI 0.00-1.25 and 1.25, 95% CI 0.02-6.95, respectively) was found. Neither age at diagnosis of sarcoidosis nor clinical sarcoidosis features were indicators of later occurrence of malignancy. The study could not confirm previous reports of an increased occurrence of malignant neoplasms in Danish sarcoidosis patients.

[Marital status and survival in colorectal cancer]

We analysed marital status and survival from colorectal cancer among 9596 patients in a nationwide Danish study with complete follow-up of 22-26 years. After exclusion of 2294 patients with missing information, adjusted survival among married patients diagnosed with colon cancer was significantly longer (RR = 0.85; 95% CI: 0.78-0.93). We conclude that marital status does indeed prognosticate long-term survival from colon cancer. These results may have implications for psychosocial intervention after surgery for colorectal cancer.

Alpha interferon therapy in Danish haemophiliac patients with chronic hepatitis C: results of a randomized controlled open label study comparing two different maintenance regimens following standard interferon-alpha-2b treatment

Following a survey among all Danish haemophiliac patients 49 HIV-negative patients with chronic hepatitis C were offered enrollment in a randomized controlled open label study comparing two different maintenance regimens following standard interferon-alpha-2b treatment. Dose modifications and treatment discontinuation were based upon changes in transaminase levels. Forty-seven patients enrolled received 3 MU of alpha interferon thrice weekly (TIW) for 3 months. Twenty-six nonresponders had their dose increased to 6 MU TIW for an additional 3 months, while 21 responding patients continued on 3 MU TIW. At 6 months, 25 patients with a complete or a partial biochemical response were randomly allocated to either a fixed dose regimen (13 patients) (3 or 6 MU thrice weekly) or an individualized dose regimen (12 patients) tapering interferon dose from 3 or 6 MU by one-third every 2 months if transaminases were persistently normal. The remaining 22 biochemical nonresponders were followed for an additional 6 months without further treatment. After 12 months of treatment, 18 patients (38%) had a virological response, irrespective of regimen, and seven patients (16%) had a sustained virological and biochemical response after 6 months of follow up. Overall, the individualized treatment regimen did not seem to offer any advantage over the fixed dose regimen. The response to alpha interferon treatment in Danish haemophiliac patients with chronic hepatitis C immediately after treatment is comparable to that obtained in previous studies among nonhaemophiliacs. However, a sustained virological and biochemical response was seen in only 16% of treatment patients.

Infertility, fertility drugs, and invasive ovarian cancer: a case-control study

OBJECTIVE

To assess the risk of invasive ovarian cancer among infertile women treated with fertility drugs.

DESIGN

A case-control study.

SETTING

Nationwide data based on public registers.

PATIENT(S)

All Danish women (below the age of 60 years) with ovarian cancer during the period from 1989 to 1994 and twice the number of age-matched population controls. Included in the analysis were 684 cases and 1,721 controls.

MAIN OUTCOME MEASURE(S)

Influence of parity, infertility, and fertility drugs on the risk of ovarian cancer after multivariate confounder control. Risk measure(s): odds ratios (OR) with 95% confidence intervals.

RESULT(S)

Nulliparous women had an increased risk of ovarian cancer compared with parous women: OR 1.5 to 2.0. Infertile, nontreated nulliparous women had an OR of 2.7 (1.3 to 5.5) compared with noninfertile nulliparous women. The OR of ovarian cancer among treated nulliparous women was 0.8 (0.4 to 2.0) and among treated parous 0.6 (0.2 to 1.3), compared with nontreated nulliparous and parous infertile women, respectively.

CONCLUSION(S)

Nulliparity implies a 1.5- to 2-fold increased risk of ovarian cancer. Infertility without medical treatment among these women increased the risk further. Among parous as well as nulliparous women, treatment with fertility drugs did not increase the ovarian cancer risk compared with nontreated infertile women.

Influence of marital status on survival from colon and rectal cancer in Denmark

Survival from colorectal cancer has been analysed in relation to marital status in a nationwide Danish study of 9596 patients with complete follow-up of 22-26 years. After exclusion of 2294 patients with missing information adjusted five-year survival among married patients was significantly longer (RR=0.85; 95% CI 0.78-0.93).

Renal cell carcinoma: prognostic factors

OBJECTIVE

To establish the prognostic value of a series of pre-operative, per-operative and histopathological parameters in relation to renal cell carcinoma (RCC).

PATIENTS AND METHODS

This retrospective study involved a consecutive series of 76 patients (46 men and 30 women with a mean age of 65.3 years [range 44-91]) with a histologically confirmed diagnosis of RCC. Patients who were admitted over the period 1980-1984 were included. Data such as erythrocyte sedimentation rate (ESR), alkaline phosphatase level, histological tumour grade, degree of necrosis and presence of tumour vessels were evaluated in relation to actuarial survival.

RESULTS

The ESR and alkaline phosphatase level at the time of diagnosis of RCC, the histological tumour grade, degree of necrosis and presence of tumour vessels on angiography were all found to affect the actuarial length of survival significantly (P < or = 0.05 log-rank test). Macroscopic tumour demarcation estimated per-operatively by the surgeon or after surgery by the pathologist, microscopic demarcation, vascular density on histological examination, tumour diameter and vascular density on angiography were found not to affect actuarial survival significantly.

CONCLUSION

The value of establishing simple and reliable diagnostic indicators for patients with RCC is stressed.

Prognostic factors and significance of chemotherapy in patients with recurrent or metastatic transitional cell cancer of the urinary tract

BACKGROUND

Prognostic factors for patients with disseminated transitional cell carcinoma of the urothelium (TCC) has been examined only in patients selected for studies with chemotherapy. This study was performed to determine important prognostic factors in patients with disseminated TCC and evaluate the impact of chemotherapy.

METHODS

The prognostic factors for survival were analyzed in 240 patients with disseminated TCC admitted from 1976 to 1992. Information on prior medical history, baseline variables, and treatment were related to survival after dissemination. Both univariate and multivariate analyses were performed to identify factors of independent importance.

RESULTS

Univariate analyses indicated that performance status; hemoglobin; leukocyte count; platelet count; concentrations of serum creatinine, aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase; hydronephrosis; bone metastases; disease extension; and chemotherapy were related significantly to survival. Multivariate analysis demonstrated that a good performance status, a normal alkaline phosphatase concentration, and a normal serum creatinine concentration were independent prognosticators for long survival. When chemotherapy was included in the analysis, it was found to be the most important independent prognostic factor in conjunction with alkaline phosphatase and performance status.

CONCLUSION

This study has established the importance of performance status and alkaline phosphatase as the most important prognostic factors of survival in patients with disseminated TCC regardless of treatment. Chemotherapy was found to be an independent prognostic variable that indicates a possible prolongation of survival in patients receiving chemotherapy.

[Apoplexy--the acute phase]

This review concerns the acute phase of stroke. It describes incidence, prevalence, etiology, diagnosis and treatment together with the possibilities for prevention. The incidence of stroke in the Danish population is about 2/1000 person years and has been largely unchanged during the last 20 years. About 85% of strokes are caused by cerebral infarcts, ten percent by intracerebral haemorrhages and about five percent by subarachnoid bleeding. The incidence increases with age. Up till age 65 years the ratio between men and women is two to one, while the ratio in the oldest age group approaches one to one. The most important risk factors for stroke are smoking, arterial hypertension, previous cerebrovascular disease, heart disease and diabetes mellitus. Till now, no treatment has been documented as effective in reducing the cerebral damage caused by acute stroke. Ongoing controlled clinical trials in the acute state of ischaemic stroke are testing the effect of thrombolytic therapy, treatment with calciumantagonists, aspirin and heparin. The general medical treatment including nursing and physiotherapy in the acute phase is described. Within recent years benefit of various strategies of stroke prevention has been documented.

[Blood pressure among school 14-15 year old children. Blood pressure determination in school children aged 14-15 years in the county of Vejle by school physicians]

A total of 3,790 school pupils aged 14 and 15 years attending the ninth form during the school session 1986/87 were submitted to blood pressure measurements employing a digital sphygmomanometer. Where boys were concerned an average blood pressure of 123.9/65.9 mmHg was found while, in girls, the average blood pressure was 117.6/70.9 mmHg. In cases with blood pressure readings over the 90% fractile, repeated measurements are recommended. The 90% fractile for boys was 139/80 mmHg and for and for girls 133/84 mmHg. In cases where repeated measurements show blood pressure readings over the 95% fractile, further investigation and advice about risk factors are recommended. The 95% fractile for boys was 144/84 mmHg and 138/88 mmHg for girls. The influence of pubertal development and body-weight on the blood pressure are reviewed. Screening in connection with health examination in the ninth form is recommended in order to identify adolescents at risk for development of hypertension.

Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. A randomized, double-blind study

The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The children received the antibiotics for 6 months. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n = 60) as evaluated by actuarial percentage recurrence-free analysis (p = 0.0025). However, no differences was found in patients without urinary tract abnormalities. Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76% trimethoprim resistant bacteria during prophylaxis, compared with 8% before (p less than 0.0001) and 17% after (p less than 0.0001) prophylaxis. The percentage of recurrences due to E. coli (70-80%) was unaffected by trimethoprim prophylaxis, but the proportion due to trimethoprim resistant E. coli was significantly higher during prophylaxis (65%) than before (6%, p less than 0.0001) and after (11%, p less than 0.001). The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). Following prophylaxis there was no difference in the actuarial percentage recurrence-free curves of the two regimens. Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21%) (p = 0.05). The majority of side effects in the nitrofurantoin group derived from gastrointestinal symptoms. In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities.

Malignancy in ulcerative colitis

All patients with ulcerative colitis referred to Rigshospitalet, Copenhagen, from 1 April 1964 to 1 January 1983 (18 years and 9 months) were studied from time of referral until death, proctocolectomy, or end of the study (1983). There were 759 patients, 423 females (56%) and 336 males (44%). None was lost to follow-up study. Median time from onset of disease until death, proctocolectomy, or end of the study was 11 years (range, 0-54 years). Median age at onset was 28 years (range, 0-83) among the males and 28 years (range, 4-83) among the females. Pancolitis was present in 312 patients (41%), left-sided colitis in 212 (28%), and haemorrhagic proctitis in 235 (31%). Surgical treatment was performed in 299 patients (39%): proctocolectomy in 197 (26%), colectomy with occluded rectal stump in 72 (9%), and colectomy with ileorectal anastomosis in 30 (4%). Altogether, 49 patients developed cancer, 20 being intestinal and 29 extraintestinal cancer. Compared with the general population matched for age, sex, and calendar time, there was an excessive number with intestinal cancer in both sexes (p less than 0.05). In females the number with extraintestinal cancer was higher than in the general population (p less than 0.01), a finding that has not been reported elsewhere. We found a similar, significantly increased incidence of extraintestinal cancer in females with Crohn's disease in a previous report. We found no increased risk of colorectal cancer in patients with early onset of ulcerative colitis. For all age classes we found that the age of appearance of colorectal cancer followed the equation: age at colorectal cancer = 14 + age at onset of ulcerative colitis. We found no higher potential for development of colorectal cancer in patients with pancolitis. In our series the incidence of colorectal cancer in pancolitis and left-sided colitis was equal. The incidence in patients with haemorrhagic proctitis was zero.

Bowen's disease and internal malignant diseases. A study of 581 patients

In a retrospective study of 581 patients with a diagnosis of Bowen's disease (BD) treated over a 40-year period, we traced patient records to identify later diagnoses of nonskin cancer. Fifty patients had nonskin cancer, as against an expected number of 40, but this difference was not significant. The lack of association was equally true for BD on sun-exposed and non-sun-exposed skin. Our findings support the view that BD is not a skin marker for internal malignant disease.

The joint effect of risk factors on endometrial cancer

The joint effect of risk factors on endometrial cancer was examined by applying general statistical models to the data of a hospital-based case-control study conducted in Copenhagen, Denmark. The analysis included 149 cases of histologically confirmed adenocarcinoma of the endometrium and 154 age-matched controls with cervical cancer. Information on risk factors derived from the medical records. Estrogen use and body mass were found to be the main predictors of endometrial cancer risk. In the model proposed, women who ever used non-contraceptive estrogens had a 10-fold increased risk irrespective of their weight and height. Among non-users of estrogen, the risk of endometrial cancer rose with increasing body mass, the largest showing a five-fold increased risk. These data provide further evidence of the significant role that excess estrogens play, whether exogenous from replacement therapy or endogenous from enhanced androgen conversion, in the etiology of endometrial cancer.

Breast cancer incidence subsequent to surgical reduction of the female breast

The incidence of breast cancer was determined in 1245 women who were treated surgically for breast hypertrophy in Copenhagen, Denmark, between 1943 and 1971. Breast cancer cases were identified by a linkage to the Danish Cancer Registry. The expected number of breast cancers was estimated from age and calendar-time specific incidence rates in the Danish female population. A total of 18 breast cancers developed compared to 30.28 expected, yielding a relative risk (RR) of 0.59 (95% confidence interval (CI) 0.35-0.94). The greatest risk reduction was observed ten or more years after the plastic surgery operation in women who had 600 g or more of breast tissue removed (RR = 0.27; 95% CI 0.03-0.99). This suggests that the number of potential foci are important for cancer development in the breast.

Updating prognosis and therapeutic effect evaluation in cirrhosis with Cox's multiple regression model for time-dependent variables

A multivariate Cox regression analysis with time-dependent variables has been performed on the data of 415 patients with cirrhosis included in a controlled clinical trial of 10-15 mg prednisone daily versus placebo. The analysis showed that a poor prognosis was associated with a low prothrombin index, marked ascites, GI bleeding, high age, high daily alcohol consumption, high bilirubin and alkaline phosphatase and low albumin values, little liver connective tissue inflammation, and poor nutritional status. Prothrombin index and ascites showed significant interaction with the treatment in such a manner that high prothrombin index and absence of ascites were associated with a beneficial effect of prednisone, whereas low prothrombin index and presence of ascites were associated with a harmful effect of prednisone treatment. The final model was validated in independent patients by comparing their actual survival with that predicted from the model, using a split-sample testing technique. The prognostic factors were combined with an index that can be used to update prognosis whenever changes occur in the clinical status of a patient during the course of the disease. The probability of surviving the next 3 or 6 months can be estimated from the prognostic index at any time during the course. The index may be of value for the correct timing of special therapeutic procedures such as liver transplantation.

Malignancy in Crohn's disease

The incidence of cancer in Crohn's disease has been evaluated in 473 patients admitted to Rigshospitalet during the period 1 April 1964 to 1 January 1983. The patients' condition at the end of the survey, their survival, and the number and location of cancers were registered. During the survey period 23 cancers (4.9%) were found. Five were intestinal (1.1%) and were split evenly among the two sexes, whereas among 18 patients with extraintestinal cancers there was only 1 man. There was no increased risk of developing cancer inside the gastrointestinal tract compared with a background population matched for age, sex, and calendar time. Extraintestinal cancer in women was, however, significantly in excess.

Second cancer following cancers of the buccal cavity and pharynx in Denmark, 1943-80

Cancers of the buccal cavity and the pharynx are not only anatomically related but, except for the nasopharynx, also have risk factors in common. Multifocal occurrence of cancers in the buccal cavity and pharynx must be kept in mind when one is interpreting findings on multiple tumors. However, susceptibility to common risk factors, predominantly alcohol and tobacco, seem to be in operation among males, inasmuch as excess lung cancer followed cancers of the tongue [relative risk (RR) = 2.2], other parts of the mouth (RR = 2.2), and pharynx (RR = 2.0). Among females, lung cancer was in excess after cancers of the tongue (RR = 3.7) and mouth (RR = 3.6). Among males, esophageal cancer was elevated after cancers of the mouth (RR = 4.7) and tongue (RR = 5.7). Other combinations of tobacco-related cancers among males include those of the bladder (RR = 2.5) after cancer of the tongue and larynx (RR = 5.4) after pharyngeal cancer. Common etiologic factors or the multifocal nature of tumors of the buccal cavity might also account for the increases of cancer of the mouth (RR = 2.6) following lip cancer and cancer of the tongue (RR = 14) following mouth cancers among males. Among females, cancer of the mouth (RR = 17) was elevated after tongue, tongue (RR = 31) after mouth, and tongue (RR = 10) after salivary gland tumors. The excess of pharyngeal cancers in women (RR = 19) following cancer of the lip may be explained by common risk factors. Observed deficits of colon cancer following cancer of the lip in males and after tongue and salivary gland tumors in females could reflect low socioeconomic status, although a deficit of stomach cancer among males (RR = 0.1) also followed cancer of the salivary glands.

Summary: multiple primary cancers in Denmark, 1943-80

The risk of developing a second primary cancer was studied among 171,749 men and 208,192 women who were reported to the Danish Cancer Registry between 1943 and 1980. Only those who survived at least 2 months were included in the analysis, and more than 1.7 million person-years of observation were accrued. Altogether, 15,084 second primary cancers developed in organs other than the initial cancer site [relative risk (RR) = 0.99]. Adjustment for possible underreporting of multiple primary cancers increased the RR to 1.06. The overall RR of a second cancer developing for all sites was 0.91, but interpretation of this risk is difficult because new tumors arising within the same organ are generally not recorded in Denmark. The RR for all sites increased with time from 0.94 during the first decade of follow-up (excluding the first year) to 1.13 among 30-year survivors. Patients below the age of 20 years when first diagnosed with cancer experienced significantly increased risk of developing a second cancer. Elevated risks were also observed for sites thought to have a common etiology. For example, cancers of smoking-related sites were increased in both directions for cancers of the oral cavity, respiratory tract, and urinary organs. For cancers suspected to have a hormone- or dietary fat-related association, significant reciprocal relationships were seen among cancers of the endometrium, ovary, and colon. Cancer treatment probably is an important factor in second cancer development, even when judged indirectly in the present study. For example, radiotherapy may have been responsible for an elevated risk of subsequent cancers of the thyroid, breast, colon, rectum, bladder, connective tissue, and hematopoietic system in long-term survivors. Chemotherapy may have increased the risk of subsequent leukemias. Our data further indicate that cancer patients have no general susceptibility to develop new malignant tumors, although high rates may be found for particular sites sharing common risk factors. Conversely, the occurrence of one cancer does not appear to protect against developing a new cancer.

Therapeutic and clinico-pathological factors in the survival of 1,469 patients with primary cutaneous malignant melanoma in clinical stage I. A multivariate regression analysis

Therapeutic and clinico-pathological data of 1,469 patients with clinical stage I malignant melanoma of the skin without histological evidence of fibrotic areas of regression were examined by multivariate regression analysis. In accordance with a previous analysis anatomical site of tumour, tumour thickness, level of invasion, mitotic rate, ulceration, lymphocytic reaction, dominant type of invasive tumour cell, and sex were found to act as independent risk factors. The present analysis, furthermore, showed that size of resection margin, diagnostic biopsy, removal of the deep fascia, age at surgery, as well as presence and depth of nevus cells did not influence prognosis when adjusting for the independent risk factors.

Prognostic factors in primary cutaneous malignant melanoma

Cox's multivariate regression model for survival data was applied to facts in cases of 2,012 patients with primary cutaneous malignant melanomas in order to evaluate the relative prognostic value of numerous clinicohistologic variables and to establish their prognostically most meaningful combination. The variables that were found to be independent risk factors were clinical stage, site of lesion, thickness of lesion, level of invasion, mitotic figures, ulceration, lymphocytic infiltrate, predominant type of neoplastic cell, and regression. The factors that were found to be without prognostic significance were histological type, nuclear pleomorphism, nucleolar size, vascular invasion, pigmentation, and attendant solar elastosis. The prognostic effects of sex and age of patients were uncertain, and both variables therefore were retained in the model.

Biopsy and optimal size of margins of resection of primary cutaneous malignant melanomas

Cox's multivariate regression analysis for survival data was applied to facts in 1,469 clinical Stage 1 cutaneous malignant melanomas without areas of regression in order to evaluate the prognostic value of size of margins of resection and preliminary biopsy as well as sex and age of patients when accounting for variables previously shown as independent risk factors, i.e., site of lesion, thickness of lesion, level of invasion, number of mitotic figures, ulceration, lymphocytic infiltration, and predominant type of neoplastic cell. These variables were also found to be independent risk factors together with sex of patient in the present study. In contrast, size of margins of resection, preliminary biopsies, and ages of patients were found to be without prognostic significance.

Survival with primary cutaneous malignant melanoma, evaluated from 2012 cases. A multivariate regression analysis

Cox's multivariate regression model for survival data was applied to 2,012 patients with primary cutaneous melanoma in order to evaluate the relative prognostic value of numerous clinical and histological variables and to establish their prognostically most efficient combination. The material was divided into 4 groups according to the size of resection margin of the primary lesion (less than 2.0 cm, 2.0 cm, 2.1-4.9 cm, and greater than or equal to 5.0 cm). Data were analysed separately in these 4 groups and equivalent results were obtained. The risk factors were clinical stage, site of tumour, tumour thickness, level of invasion, mitotic activity, ulceration, lymphocytic reaction, predominant type of invasive tumour cell and partial regression. When accounting for these factors, histological type, nuclear pleomorphism, nucleolar size, vascular invasion, pigmentation, verrucous growth pattern, and dermal elastosis were without prognostic influence. The effect of sex and age of patient was uncertain and both variables, therefore, were retained in the model. By using Cox's method it is possible to make a qualified estimate of the survival for the individual patient.

Clinical trial with levo-norgestrel and testosterone oenanthate for male fertility control

Two groups of six men took levo-norgestrel (250 or 500 microgram daily) by mouth and testosterone oenanthate (200 mg monthly, intramuscurlarly) for six months. A three months placebo period preceded the medication which was followed by a recovery phase of 6-10 months. Two volunteers withdrew due to side effects. The five men taking the low doses of levo-norgestrel (250 microgram) exhibited a reduction in sperm count, but not to azoospermia. The high dose of levo-norgestrel (500 microgram) was more effective, sperm count was reduced to < 6 X 10(6)/ml in 3 of 5 volunteers and to < 17 X 10(6)/ml in the remainder. s-Testosterone, LH and FSH were decreased by the treatment. The men had no toxicological side effects or changes in libido and potency. During the recovery period sperm counts, sperm morphology, s-testosterone, LH and FSH returned to normal levels.

Clinical evaluation of long-term treatment with levo-norgestrel and testosterone enanthate in normal men

Thirteen healthy men (25-35 years) with proven fertility were scheduled for long-term treatment (> 12 months) with levo-norgestrel (500 micrograms daily) and testosterone enanthate (200 mg monthly). The volunteers were regularly investigated prior to, during and after treatment. Seven volunteers withdrew from medication after 1 to 12 months of treatment; three due to psychological side effects, one because of stiffness of a finger joint, two for personal reasons and one for unspecified reasons. Sperm counts were significantly decreased during treatment and in 7 volunteers the sperm counts were < 5 x 10(6)/ml. However, two of these volunteers exhibited a breakthrough in sperm counts after 12 and 13 months of a 16-month treatment period. Serum testosterone, serum LH and serum FSH were significantly decreased during treatment, but returned, as did sperm counts, to normal levels after withdrawal of treatment. No rebound effect was seen. Potency and libido remained unchanged. No toxicological side effects were observed and finally no consistent changes were seen in blood coagulation parameters.

Oral levo-norgestrel - testosterone effects on spermatogenesis, hormone levels, coagulation factors and lipoproteins in normal men

Four healthy men volunteered to be treated for eight to nine months with daily oral levo-norgestrel (250 micrograms) and oral testosterone (200-600 mg) as a possible contraceptive. This was followed by a recovery phase of 5-10 months. The oral steroid combination significantly decreased sperm count in 3 of 4 subjects, and significantly increased abnormal spermatozoa, serum LH was decreased during treatment but serum FSH remained constant, except for one volunteer. Serum testosterone was decreased except for 2 daily peaks associated with the oral testosterone. During the recovery period, sperm counts and morphology, serum testosterone and serum LH returned to normal, whereas serum FSH levels were increased. Platelet aggregability induced by ADP, increased in 3 volunteers during treatment as did fibrinolytic activity and fibrinolytic capacity (2 of 3 subjects). There was a reduction in the hepatic triglyceride lipase activity but no change was seen in serum triglycerides, serum cholesterol, serum LDL, serum HDL, peripheral lipoprotein lipase activity and the intravenous fat tolerance test. No other toxicological side effects were seen.

The effects of low doses of cyproterone acetate on some functions of the reproductive system in normal men

One daily dose of either 5 mg or 10 mg cyproterone acetate (CA) was administered to 2 groups of 4 fertile men for 6 months. The medication was preceded by a 3 months placebo period and followed by a recovery phase of 5 to 8 months. During CA-treatment the sperm count/ml decreased and the percentage of abnormal spermatozoa increased slightly (0.991 less than P less than 0.05). Sperm penetration assessed by the Kremer test did not show any decrease during treatment. Serum levels of testosterone and FSH decreased, but those of LH remained unchanged during treatment. Two pregnancies occurred after 13/4 and 51/2 months of CA-treatment. The serum-CA concentration in these 2 volonteers did not differ from that of the remainder. Three subjects who began the study were withdrawn because of depressive mood changes (2) and weakness combined with dizziness (1). Data from these subjects were not included. The results indicate that daily doses of 5 mg and 10 mg of cyproterone acetate are not effective as a male contraceptive.