Globally, the number of people suffering from multiple sclerosis (MS) is more than two million, and MS is characterized by increasing symptom development over time. The socio-economic costs are enormous. Therefore, effective management of MS is of great importance. Multidisciplinary rehabilitation (MR) seeks to prevent and stop loss of function and trains the patients to deal with symptoms and challenges that will arise in the future. Because there is a need for high-quality evidence of the effectiveness of MR, the MS hospitals in Denmark have initiated the largest study of its kind on MR.
In Denmark about 40 new cases of cancer of the penis are diagnosed each year. Several studies have retrospectively investigated the treatment results in this rare disease. However, most of these studies include few patients and are difficult to compare because several classification systems have been used. Treatment of the primary tumour consists of local excision, laser surgery, partial/total penectomy or irradiation. The prognosis for early stage disease is apparently independent of the mode of treatment and the specific five-year survival rate is 80-90%. Several centres advise prophylactic treatment of the groin in node negative patients, claiming that the survival thereby is increased. However, the morbidity is considerable and randomized studies are not available. The treatment for metastatic inguinal nodes consists of adenectomy or irradiation. The specific five-year survival rate is 40-50%. Chemotherapy has been used for advanced disease. The response rates are low and the responses are of short duration.
The pathology, etiology and epidemiology of anal cancer (CA) and the treatment and prognostic factors are reviewed. CA is a rare disease. However, the incidence is rising and is now 0.7 per 100,000 women and 0.4 per 100,000 men in Denmark. The median age is 60 years. Smoking and infection with human papillomavirus or HIV increases the risk of CA. The most important prognostic factors are tumour size, depth of invasion, inquinal lymph node involvement, differentiation and DNA ploidy. Previously CA was treated with abdominoperineal resection. Now sphincter preserving treatment with radiotherapy either alone or in combination with chemotherapy is preferred in most centers. Its is unsettled whether combined treatment is superior to radiotherapy only. Careful follow-up is warranted in order to perform salvage surgery in case of recurrent disease.