Hydrochlorothiazide, one of the most frequently used diuretic and antihypertensive drugs in the United States and Western Europe, is photosensitizing and has previously been linked to lip cancer. To examine the association between hydrochlorothiazide use and the risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). From the Danish Cancer Registry, we identified patients (cases) with nonmelanoma skin cancer (NMSC) during 2004-2012. Controls were matched 1:20 by age and sex. Cumulative hydrochlorothiazide use (in 1995-2012) was assessed from the Danish Prescription Registry. Using conditional logistic regression, we calculated odds ratios (ORs) for BCC and SCC associated with hydrochlorothiazide use. High use of hydrochlorothiazide (≥50,000 mg) was associated with ORs of 1.29 (95% confidence interval [CI], 1.23-1.35) for BCC and 3.98 (95% CI, 3.68-4.31) for SCC. We found clear dose-response relationships between hydrochlorothiazide use and both BCC and SCC; the highest cumulative dose category (≥200,000 mg of HCTZ) had ORs of 1.54 (95% CI, 1.38-1.71) and 7.38 (95% CI, 6.32-8.60) for BCC and SCC, respectively. Use of other diuretics and antihypertensives was not associated with NMSC. No data on sun exposure were available. Hydrochlorothiazide use is associated with a substantially increased risk of NMSC, especially SCC.

Epidemiologic data on local complications after breast augmentation are scarce. In particular, few prospectively collected data are available on modern breast implants on this issue. Using data from the Danish Registry for Plastic Surgery of the Breast, the authors examined determinants of surgery-requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3–4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically within the study period. Submuscular placement of the implant decreased the risk of capsular contracture grades III to IV (RR, 0.3; 95% CI, 0.2–0.8), whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture. Current surgical practices and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past. This prospective study indicates that surgical procedures are more important predictors for local (short-term) complications than implant or patient characteristics.

Background: Adoptive cell therapy may be based on isolation of tumor-specific T cells, e.g. autologous tumor infiltrating lymphocytes (TIL), in vitro activation and expansion and the reinfusion of these cells into patients upon chemotherapy induced lymphodepletion. Together with high-dose interleukin (IL)-2 this treatment has been given to patients with advanced malignant melanoma and impressive response rates but also significant IL-2 associated toxicity have been observed. Here we present data from a feasibility study at a Danish Translational Research Center using TIL adoptive transfer in combination with low-dose subcutaneous IL-2 injections. Methods: This is a pilot trial (ClinicalTrials.gov identifier: NCT00937625) including patients with metastatic melanoma, PS ≤1, age <70, measurable and progressive disease and no involvement of the central nervous system. Six patients were treated with lymphodepleting chemotherapy, TIL infusion, and 14 days of subcutaneous low-dose IL-2 injections, 2 MIU/day. Results: Low-dose IL-2 considerably decreased the treatment related toxicity with no grade 3–4 IL-2 related adverse events. Objective clinical responses were seen in 2 of 6 treated patients with ongoing complete responses (30+ and 10+ months), 2 patients had stable disease (4 and 5 months) and 2 patients progressed shortly after treatment. Tumor-reactivity of the infused cells and peripheral lymphocytes before and after therapy were analyzed. Absolute number of tumor specific T cells in the infusion product tended to correlate with clinical response and also, an induction of peripheral tumor reactive T cells was observed for 1 patient in complete remission. Conclusion: Complete and durable responses were induced after treatment with adoptive cell therapy in combination with low-dose IL-2 which significantly decreased toxicity of this therapy.

ALTHOUGH BREAST implant rupture is a well-known complication of breast implant surgery, little is known about the timing and frequency of ruptures.¹ In Europe, silicone breast implants are still the preferred implants for cosmetic and reconstructive breast surgery, whereas in the United States saline implants have been standard since 1992, when the use of silicone gel implants was restricted to patients enrolled in clinical trials.² Rupture of saline implants becomes apparent shortly after its occurrence due to absorption of the leaking saline. By contrast, silicone gel implant rupture often remains unnoticed by both patient and physician because the leaking silicone is kept in place by the surrounding fibrous scar membrane and no visible reabsorption occurs.^3,4 Several clinical studies have estimated the prevalence of implant rupture based on findings at explantation,^5-13 and attempts to estimate implant survival based on pooling of explantation data have been made.^14-17 However, because these studies are mainly based on symptomatic women seeking surgery, they constitute a biased selection of women with breast implants, presumably resulting in overestimation of rupture frequency. Recently, 2 studies using magnetic resonance imaging (MRI) in women with cosmetic silicone breast implants, randomly selected from larger cohorts of women with implants, reported rupture prevalences of 26% for implants with a median time in situ of 12 years⁴ and 55% for implants with a median time in situ of 16.4 years.¹⁸ However, rupture prevalence can only be used, at best, as a surrogate measure for incidence,¹⁹ and to our knowledge no study has directly examined the incidence rate of implant rupture.

Background: Groin pain is a diagnostic and therapeutic challenge to sports medicine. The literature provides no consensus on definitions of or diagnostic criteria for groin pain in athletes. To compare the results of research and treatments, the methods used to diagnose and evaluate the degree of groin pain must be clearly defined and reproducible. Objectives: To describe clinical examination techniques for groin pain in athletes and evaluate the intraobserver and interobserver reliability of these. Methods: Eighteen athletes, nine with sports related groin pain and nine without groin pain, were examined by two doctors and two physiotherapists. The examiners were trained in the examination techniques before the study. The examiners were blinded to the symptoms and identity of the subjects. The subjects were examined twice by each examiner in random order. The examinations included evaluation of adductor muscle related pain and strength, iliopsoas muscle related pain, strength, and flexibility, abdominal muscle related pain, and strength and pain at the symphysis joint. Kappa statistics and percentage of agreement were used to evaluate the data. Results: Overall, the κ values and percentage of agreement were in accordance and showed good reliability of the examinations. The κ values for the intraobserver agreement were above 0.60 in 11 of 14 tests, and those for the interobserver agreement of the pain tests were above 0.60 in eight of 10 tests. The only test without acceptable interobserver reliability was the strength test for iliopsoas muscle. Conclusion: All but one of the tests investigated were reproducible and subject only to limited intraobserver and interobserver variation.

Concern has been raised recently regarding the absence of information on the occurrence and severity of local complications after cosmetic breast implantation. The authors evaluated the occurrence of local complications in a large epidemiological retrospective cohort study of women with cosmetic breast implants in Denmark. All women with breast implants were identified from the files of two private clinics of plastic surgery in Denmark. Information on implant characteristics, surgical procedure, as well as short- and long-term complications was obtained through medical record review. Patient characteristics were obtained through a self-administered questionnaire. A total of 754 women (1,572 implants) had at least one cosmetic implantation performed at the study clinics. Average age at implantation was 32 years. Implant types included silicone double lumen with textured surface, 31.2%; silicone single lumen with textured surface, 27.8%; silicone single lumen with smooth surface, 24.5%; silicone double lumen with smooth surface, 0.8%; and other or missing information, 15.7%. Average implant size was 247 ml (range, 110–630 ml). Placement was submuscular for 91.3% of implants, subglandular for 2.6%, and 6.1% had no available information. Overall, 77.8% of implantations were not followed by complications, 17.8% were followed by one complication, 3.6% were followed by two complications, and 0.8% were followed by three or more complications. In 94.6% of implantations, no additional hospitalizations were recorded as a result of complications. Forty-seven of 57 explantations/reimplantations were secondary to postoperative complications. General complications such as hematoma and infection were rare, occurring in 2.3% and 2.0% of implantations respectively. Capsular contracture remains the most common complication, occurring in 11.4% of implantations. In this investigation, among the first epidemiological studies of local complications, the authors found cosmetic breast implant surgery to be associated with a low frequency of normal surgical complications such as infection, hematoma, and wound dehiscence. Most complications were mild and did not lead to additional hospitalization. The complication that led most frequently to the need for additional surgery/hospitalization was capsular contracture. Kjøller K, Hölmich LR, Jacobsen PH, Friis S, Fryzek J, McLaughlin JK, Lipworth L, Henriksen TF, Jørgensen S, Bittmann S, Olsen JH. Epidemiological investigation of local complications after cosmetic breast implant surgery in Denmark.