[Effect of transcutaneous electric muscle stimulation on postoperative muscle mass and protein synthesis]
Vinge OD. Edvardsen L. Jensen FK. Lassen FG. Wernerman J. Kehlet H.
H:S Hvidovre Hospital, kirurgisk gastroentrologisk og rontgendiagnostisk afdeling.
In an experimental study, 13 patients undergoing major elective abdominal surgery were given postoperative transcutaneous electrical muscle stimulation (TEMS) to the quadriceps femoris muscle on one leg, where the opposite leg served as a control. Changes in cross sectional area (CSA) and muscle protein synthesis were assessed by CT-scan and percutaneous muscle biopsies for ribosome analysis before surgery and on the sixth postoperative day. The percentage of polyribosomes in the ribosome suspension decreased significantly (p < 0.03) after operation in control legs, but not in stimulated legs (p > 0.16). The total concentration of ribosomes decreased significantly in TEMS legs (p < 0.03), but not in control legs (p > 0.16) CSA decreased significantly in both legs. The decrease in polyribosomes and CSA after operation was significantly less in TEMS legs than in controls (p < 0.05). TEMS may be a simple and effective method to improve muscle protein synthesis and muscle mass after abdominal surgery and should be evaluated in other catabolic states with muscle wasting.
[Bacterial gastroenteritis in hospitalized patients in Roskilde county 1991-1993]
Petersen AM. Nielsen SE. Meyer D. Ganer P. Ladefoged K.
Statens Serum Institut, afdeling for mave-/tarminfektioner.
Denmark has in recent years experienced a rise in the number of bacterial gastrointestinal infections. We have reviewed patients hospitalized with culture confirmed bacterial gastroenteritis in Roskilde County during 1991-1993. Two hundred and seven patients were included, 68 were children (< 15 years). The microorganism isolated was Salmonella in 61% of the cases. Campylobacter in 20% and Yersinia enterocolitica in 13%. Ninety-three percent of the patients had diarrhoea, 74% had fever (> 38 degrees C), and 66% abdominal pain. Blood in the stools was most frequent in patients infected with Campylobacter. Leucocytosis was rare. Twenty-four patients had bacteraemia. Reactive arthritis occurred in 4.8%. Three patients died, all infected with zoonotic Salmonella types. Three stool cultures were made for 115 patients, and all three cultures were positive in 73% of these patients. Bacterial gastroenteritis requiring hospitalization in Roskilde County, 1991-1993 affected mainly children and young adults. Infections due to zoonotic Salmonella types were more severe than Campylobacter and Yersinia enterocolitica gastroenteritis. It seems necessary to collect at least three stool cultures to secure a bacteriological diagnosis.
[Rectal hemorrhage. Colorectal cancer and polyps in patients aged 40 and over seeking consultation]
Norrelund N. Norrelund H.
Aarhus Universitet, Forskningsenheden for Almen Medicin.
The objective was to determine the frequency of neoplastic conditions in patients presenting in general practice with rectal bleeding and to explain the associations between presenting symptoms and final diagnoses. We conducted two studies in which we invited Danish general practitioners to register three to four patients aged 40 and over presenting with rectal bleeding. In study 1 among 208 patients aged 40 and over and presenting with a first episode of rectal bleeding, colorectal cancer and polyps were present in 15.4 and 7.7%, respectively. In study 2 among 209 patients aged 40 and over and presenting with overt rectal bleeding, 156 reported it as either the first bleeding episode or a change in their usual bleeding pattern, and in this group colorectal cancer and polyps were diagnosed in 14.1 and 11.5% respectively. A joint analysis of the two study populations showed that only age and change in bowel habits contributed to differentiating the cancer from the non-cancer patients.
[Perforation of the rectum--caused by blunt injury]
Fries J. Jensen AL. Hillmose LA.
Rontgenafdelingen, Centralsygehuset i Slagelse.
A case of perforation of the rectum in a victim of a car crash who suffered pelvic fracture is reported. Seatbelt use, diagnosis, principles of treatment and complications are reported. Rectal perforations caused by blunt trauma is unusual and has a poor prognosis.
[Risk of colorectal cancer and other cancer diseases in patients with gallstones]
Johansen C. Chow WH. Jorgensen T. Mellemkjaer L. Olsen JH.
Sektor for kraeftepidemiologi, Kraeftens Bekaempelse, Kobenhavn. email@example.com
In a nationwide cohort of gallstone patients we evaluated the hypothesis that gall stones are associated with an increased risk of cancer of the colon. In the Danish Hospital Discharge Register we identified 42,098 patients with gallstones diagnosed in 1977-1989. These patients were linked to the Danish Cancer Registry in order to assess their risks of colorectal and other cancers during follow-up to the end of 1992. The analysis showed a modest increase in the number of cancers at all sites combined (N = 3940; RR = 1.07; 95% CI = 1.0-1.1). A weak association was found for cancer of the colon (N = 360; RR = 1.09; 95% CI = 1.0-1.2), which remained unchanged when analysed by sex, anatomical subsite and duration of follow-up. Multivariate analysis with adjustment for cholecystectomy and clinically defined obesity did not change these estimates to any significant extent. A nonsignificantly increased risk of breast cancer was seen in women five years after initial discharge for gallstones.
[Marital status and survival in colorectal cancer]
Johansen C. Schou G. Soll-Johanning H. Mellemgaard A. Lynge E.
Sektor for kraeftepidemiologi, Kraeftens Bekaempelse, Kobenhavn. firstname.lastname@example.org
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.
Moller S. Henriksen JH.
Klinisk fysiologisk/nuklearmedicinsk afdeling, H:S Hvidovre Hospital.
Fluid and sodium retention with peripheral oedema and ascites are often seen in decompensated patients with diseases of the liver, kidney and heart and in malignancies. Despite a careful clinical examination including relevant biochemical tests, decompensation is associated with diagnostic challenges. Two cases are presented where a haemodynamic investigation of the splanchnic and systemic circulation contributed to the establishment of a correct diagnosis, and the advantages of this diagnostic tool are discussed.
[Results after surgery of incisional hernias]
Madsen SS. Ejstrud P. Haugaard K. Jepsen MH. Mortensen J. Nilsson T.
Aalborg Sygehus, kirurgisk gastroenterologisk afdeling A.
The purpose of this paper is to describe the subjective results after operation for ventral hernia. Patients operated for ventral hernia in the period from January 1, 1988 to December 31, 1992 were sent a questionnaire with a response rate of 87%. Forty-five percent had lasting discomfort, 30% were absent due to illness more than eight weeks after the operation and 22% were not able to go to work. These factors increase with the number of hernia operations. Regardless of the number of operations, about 70% of the patients wanted a new operation should the hernia recur. It is therefore important to give the patient an objective and detailed information to prevent from unrealistic expectations of the results of ventral hernia operation.
[Recommendations for convalescence after hernia surgery. A questionnaire study]
Kehlet H. Callesen T.
H:S Hvidovre Hospital, kirurgisk gastroenterologisk afdeling.
To determine differences in recommendations for convalescence after inguinal herniorrhaphy, a questionnaire was mailed to 294 general practitioners in the Copenhagen area. Sixty-two percent returned the questionnaire. After primary hernia repair a period of 1-12 weeks off work was recommended (mean 2.6, 4.1 and 7.8 weeks in patients with light, moderate or heavy work load, respectively). After repair for recurrent hernia 1-24 weeks off work were recommended (mean 3.5, 5.4 and 8.3 weeks in patients with light, moderate or heavy work load, respectively). Restrictions in lifting (> 5 kg) were recommended for 1-16 weeks, mean 6.1 and 7.4 weeks after primary and recurrent repair, respectively. It is concluded that there is a need for propagation of new data regarding shortened convalescence after herniorrhaphy in order to maximise the advantages of new surgical and analgesic techniques.
[Randomized trial of three types of repair used in 324 consecutive operations of hernia. A study of the frequency of recurrence]
Farso Sygehus, kirurgisk afdeling.
In order to assess the recurrence-rate of the commonly used repairs of inguinal hernia: Bassini, McVay and Shouldice, 324 consecutive non-recurrence hernias were randomly allocated to one of those repairs. The age range 18-65 years. Ninety-six percent of the operations were carried out by the author. After a median observation-period of 32 months (range 5-75), ten recurrences had occurred, two Bassini, four McVay and four Shouldice, showing no significant differences in recurrence rate between the three types of repair. All recurrences were re-operated, five of them suffered a second recurrence. Other complications occurred in 36 patients (11%). With extensive training, low recurrence-rates can be achieved with any of the above-mentioned repairs. It is recommended that herniasurgery be centralised, and that other outcome-measures than recurrence be scrutinized as well.
[Organization and results of ambulatory surgery for inguinal hernia]
Bech K. Callesen T. Nielsen R. Roikjaer O. Andersen J. Hesselfeldt P. Kehlet H.
H:S Hvidovre Hospital, kirurgisk gastroenterologisk afdeling.
The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.
[Clinics for counseling on cancer genetics. Experiences with genetic studies and counseling on familial breast cancer and colorectal cancer]
Gerdes AM. Rasmussen K. Graversen HP. Kronborg O. Qvist N. Holm NV. Axelsson CK. Rose C. Ahrons S. Dyreborg U. Horder M.
Odense Universitetshospital, afdeling KKA.
Five to ten percent of cases of breast cancer and colorectal cancer are familial. These families can be divided into high-risk families and moderate-risk families. Cancer in high-risk families can often be explained by dominant inheritance of a gene causing increased susceptibility to cancer. There is a great demand for genetic counseling in these families, and the structure of and experiences from a familial cancer clinic at Odense University Hospital is described. The establishment of a familial cancer clinic involves three steps: 1) Identification of families with increased cancer susceptibility; 2) Molecular tests to identify gene carriers; 3) Clinical examinations for early detection of tumors. Achievement of these three steps requires the involvement of several medical specialties to ensure patient care. Experience with familial cancer clinics is still limited and the involvement of genetic testing and clinical examination programs at risk individuals are insufficiently examined. The rapidly improving techniques for genetic testing make it urgent that it is implemented as part of already established clinical programs.
[Ogilvie syndrome treated by ileostomy]
Vejle Sygehus, organkirurgisk afdeling.
Ogilvie's syndrome (acute pseudoobstruction of the colon) is characterized by acute massive dilatation of the caecum and right colon without organic obstruction. If untreated, distension may cause perforation, peritonitis, and death. Colonoscopic decompression of the colon is the treatment of choice and should be attempted cautiously as soon as the diagnosis is made. If colonoscopy is unavailable or unsuccessful, double-tubed ileostomy and enemas in the anal tube of the stoma is a safe and effective form of treatment.
[Occupational and chronic inflammatory bowel disease in Denmark]
Boggild H. Tuchsen F. Orhede E.
Aalborg Sygehus, arbejdsmedicinsk klinik. email@example.com
It has been suggested that some occupational groups have a high risk of contracting chronic inflammatory bowel diseases. A cohort, comprising 2,273,872 male and female Danes aged 20-59 on 1 January 1981, and a cohort similarly defined as of 1 January 1986 were followed up for hospitalizations due to chronic inflammatory bowel disease until 31. December 1990. From 1981 to 1990, 6296 first time admissions occurred. Among 15 groups previously found to be at high or low risk only female office staff and health personnel had statistically significantly increased standardized hospitalization ratios. Occupations with non-daytime work did not have an increased risk. Occupations with predominantly sedentary work had a standardized hospitalization ratio of 125 (95% confidence interval 116.9-133.1) compared to occupations without sedentary work. Self-employed had low hospitalization rates, while 'other salaried staff' and "not economically active" had high rates.
[Malignant melanoma in the small intestine]
Sorensen YA. Larsen LB.
Sygehus Fyn, Faaborg, kirurgisk afdeling og rontgenafdeling.
A case story of malignant melanoma is presented. The tumour was localised to the jejunum. The symptoms, diagnosis and treatment are described and the pathogenesis is discussed.
[Transjugular intrahepatic portosystemic shunt. Treatment of patients with recurrent bleeding from esophageal varices]
Struckmann JR. Mygind T. Skjoldbye B. Schlichting P. Burcharth F.
Kirurgisk gastroenterologisk afdeling, Amtssygehuset i Herlev.
We report the results of transjugular intrahepatic portosystemic shunt (TIPS) procedure in six patients with liver cirrhosis and recurrent bleeding or acute intractable bleeding from oesophageal varices in spite of multiple sessions of sclerotherapy. Median follow-up was 15 months (range 1-24 months). The procedure was technically successful in all patients without procedure-related morbidity or mortality. Four of the procedures were performed electively and two as an emergency procedure. The portosystemic pressure gradient decreased to below 12 mmHg following TIPS implantation and the shunt bloodflow was one quarter to three-quarters of the portal bloodflow determined by Doppler ultrasound. Recurrent bleeding occurred in one patient but was amenable to endoscopic sclerotherapy. In this patient the shunt had developed a stenosis that was treated by balloondilatation and insertion of an additional stent six months following the initial procedure, and no further bleeding occurred. The remaining five patients had no rebleeding episodes. Repeated Doppler examinations in the followup period demonstrated patency of all shunts. None of the patients developed portosystemic encephalopathy. One patient died of cerebral haemorrhage, unrelated to TIPS, 16 months following implantation. Another patient died 14 months following TIPS due to acute mesenteric occlusion and septicaemia. We conclude that TIPS is feasible and effective in selected patients with liver cirrhosis and persistent or recurrent variceal bleeding following repeated endoscopic therapy.
[Transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension]
Astrup LB. Solvig J. Cwikiel W.
Arhus Universitetshospital, Arhus Kommunehospital, medicinsk afdeling V.
The transjugular intrahepatic portosystemic shunt (TIPS) represents an important advance in the treatment of complications of portal hypertension. The results from the first 10 TIPS procedures in Arhus are reported. We found, as also documented in other clinical series, that TIPS is more effective in controlling acute haemorrhage than treatment with sclerotherapy and specific medical treatment. Seven out of 10 were treated for acute haemorrhage, and two patients were treated for recurrent variceal bleeding in spite of at least 20 procedures of sclerotherapy and pharmaceutical therapy. One patient was treated with TIPS due to refractory ascites. All 10 TIPS procedures were satisfactory, in four patients it was necessary to embolize collaterals. There were no acute complications associated to the TIPS procedures, but one patient developed stenosis of the shunt within one year, and another chronic encephalopathy. Two patients died, one because of sepsis with Candida albicans, and the other of intracerebral bleeding 16 months after the TIPS procedure.
[The effect of parity on anorectal function]
Ryhammer AM. Laurberg S. Hermann AP.
Arhus Universitetshospital, Arhus Amtssygehus, kirurgisk forskningsafsnit, kirurgisk afdeling L.
An observational study of 144 (mean age 50 [range 45-57] years) perimenopausal women randomly selected from the National Register was conducted in order, to study long term effects of vaginal deliveries on anorectal function. The mean number of vaginal deliveries was two (range 0-6). Measurements were perineal position at rest and during straining, anal mucosa electrosensitivity, maximum resting pressure, maximum squeeze pressure of the anal sphincters, and pudendal nerve terminal motor latency. All tests were performed by a single investigator (AMR) who had no knowledge of the subject's parity. Increasing parity correlated with a lowered perineal position at rest (correlation coefficient (r) = 0.26, p = 0.003) and during straining (r = 0.24, p = 0.006), an increased threshold of anal sensibility (r = 0.22, p = 0.008), and an increased pudendal nerve terminal motor latency (r = 0.27, p = 0.002). No effect of parity on the maximum resting pressure (r = 0.06, p = 0.70) and maximum squeeze pressure (r = 0.06, p = 0.36) was found. The number of vaginal deliveries only accounted for a minor fraction of the total variability (between 3.6-5.7%). It is concluded that repeated vaginal deliveries have a long term adverse effect on anorectal function in a population of randomly selected healthy perimenopausal women.
[Hepatitis C virus (HCV) status in recipients transfused with blood from anti-HCV-positive donors]
Riisom K. Moller A.
Arhus Universitetshospital, Skejby Sygehus, klinisk immunologisk afdeling.
Ten donors positive for antibodies to hepatitis C were discovered in the community of Aarhus after the introduction of screening of blood donors. These donors had donated blood products to 123 recipients. Of these recipients 76 were dead and 21 were not contacted for various reasons. Follow-up of anti-HCV status was performed in the remaining 26 recipients. Twenty-four (92%) of the recipients were positive in the RIBA confirmatory test, one was inconclusive and one was negative. Nine (90%) of the donors were hepatitis C virus RNA positive, while 17 (68%) of the recipients were HCV-RNA positive. Altogether (donors and recipients) 25 (76%) of the HCV-RNA positive patients had abnormal liver enzymes, while all HCV-RNA negative patients had normal enzyme levels. Eight of eleven HCV-RNA positive patients had an abnormal liver biopsy, while one patient in the HCV-RNA negative group had an abnormal liver biopsy. Three have been treated with interferon. In view of the liver damage already found only few years after transfusion, follow-up investigations in order to identify younger persons transfused with hepatitis C positive donations should be carried out and patients offered treatment if necessary. The National Board of Health has decided to recommend this strategy.
[Stab and cut lesions among general practitioners in the county of Funen]
Sondergaard J. Andersen MB.
Odense Universitet, Institut for Sygdomsforebyggelse og Helsetjeneste.
In a questionnaire sent out to general practitioners (GP) in the County of Funen they reported a yearly incidence of lesions penetrating the skin of 1.2 per practitioner. Approximately half of these lesions were potentially infectious. Sixty percent of the lesions were due to accidents involving needles. Only 52% of the GPs with the risk of a potentially infectious lesion tried to prevent infection. We estimate that the risk of becoming infected with HIV or Hepatitis-B infection is very low. It is necessary to get GPs to change procedures in an attempt to minimize the risk.
[Percutaneous blood exposure among Danish physicians. Mechanisms and prevention]
Lunding S. Nielsen TL. Nielsen JO.
Hvidovre Hospital, infektionsmedicinsk afdeling.
The study describes the mechanisms of percutaneous blood exposure (PCE) among Danish doctors and discusses rational strategies for prevention. Data were obtained as part of a nation-wide survey of occupational blood exposure. The most recent percutaneous or mucocutaneous exposure within the previous three months was described. Of 9375 doctors, 6005 (64%) participated. A total of 971 PCE were described. Inattentiveness contributed to 30.5%. Use of fingers rather than instruments was a contributing cause of 36.9% of 483 PCE on suture needles. Common concomitant causes in such cases (n = 199) were poor space in (30.2%) or view of (18.6%) the operation field. Of 689 PCE in surgical specialties, 17.4% were inflicted by colleagues. Up to 53.3% of PCE on hollow-bore needles could be attributed to unsafe routines only. In conclusion, education in safer working routines are needed in all specialties. Introduction of safer devices should have a high priority in surgical specialties, and should be considered in non-surgical specialties too.
[Dysphagia as first symptom of myasthenia gravis]
Rungby JA. Trojaborg NS. Luhdorf K.
Ore-, naese-, halsafdelingen, Amtssygehuset i Roskilde.
We present a case story of a 70-year-old female, who went through several examinations, multiple paraclinical investigations and lost 15 kg in bodyweight over a six month period, before the diagnosis myasthenia gravis (MG) was made. Dysphagia was from the early phase her most prominent and persistent complaint. However, other symptoms, thought to be allergic reactions, made the diagnosis difficult. The patient's symptoms are discussed. Most of these are consistent with MG, but on the other hand rare at the beginning of the disease. This report is a reminder that MG may present as dysphagia, addressed in particular to otolaryngologists and gastrosurgeons.
[Microsurgical laser treatment of Zenkers diverticulum. Economic aspects]
Welinder NR. Balle VH. Mantoni MY. Thomsen JC.
Ore-, naese-, halsafdeling E og rontgenafdelingen, Amtssygehuset i Gentofte.
Zenker's diverticulum (hypopharyngeal/proximal oesophageal diverticulum/pouch) is a relatively uncommon cause of dysphagia usually in elderly patients. We describe the results of the first 10 patients operated for ZD with micro-endoscopic laserdiverticulotomy (LD), where the "spur" between the diverticulum and oesophagus is coagulated by means of a CO2 laser in our department. The results are compared with the results of the last nine patients operated with conventional diverticulectomy (DE) via incision on the neck. Two patients in the DE group had complications (wound infection and pneumonia), whereas no complications were seen in the LD group. An initially good result was seen in all the patients in both groups. Symptoms recurred in 11% in the DE group (one patient), whereas this was seen in 20% of the patients in the LD group (two patients). Re-operation of these two patients in the LD group relieved the patients of symptoms, but one patient was re-operated twice before this was achieved. Surgery time was reduced by 64%. Hospitalization time was shortened from a median of 16 (9-28) days with DE to 4 (0-9) days in the LD group. These factors represent a substantial economic saving by using LD as compared to DE. To be able to evaluate the result of LD roentgenographically, it has proven necessary to produce a pure lateral view of the diverticulum both pre- and post-operatively. The size and shape of the diverticulum is mostly seen as unchanged following surgery. With a pure lateral projection, it is however possible to see how the spur between the oesophagus and the diverticulum is diminished with resulting enhanced passage of contrast and practically no retention.
[Hepatitis B vaccination status among Danish physicians]
Lunding S. Nielsen TL. Nielsen JO.
H:S Hvidovre Hospital, infektionsmedicinsk afdeling.
As part of a nation-wide questionnaire survey among Danish doctors, the incidence of hepatitis B vaccination was studied. For each specialty the findings were related to the risk of hepatitis B exposure assessed by the incidence of percutaneous and mucocutaneous blood exposure (PCE and MCE). A total of 6256 of 9375 doctors (67%) responded and 6005 (64%) questionnaires were eligible for analysis. Only 34.3% of the doctors had been vaccinated against hepatitis B, ranging from 8.9% in Psychiatry to 56.9% in Obstetrics-Gynaecology. The annual incidence of PCE and MCE was high in surgical as well as non-surgical specialties with an average of 3.0 PCE and 3.9 MCE per person. In conclusion all doctors must be considered at risk of exposure to hepatitis B during part of or the entire career. The current level of hepatitis B vaccination is insufficient. Hepatitis B vaccination of all doctors before entering clinical work seems to be indicated.
[Treatment of primary low-grade gastric lymphomas with eradication of Helicobacter pylori]
Arnesen RB. Jacobsen B.
H:S Hvidovre Hospital, kirurgisk gastroenterologisk afdeling.
There is evidence associating Helicobacter pylori (HP) with both mulosa-associated lymphoid tissue (MALT) and MALT-lymphoma. Recently, three studies including 65 patients have shown that the eradication of HP can lead to regression in about 60-70% of primary low-grade gastric B-cell MALT-lymphomas. Prolonged follow-up will be necessary to see whether these remissions are lasting, and whether eradication of HP in combination with conventional therapy is more effective than either of these treatments alone. Until then we recommend that HP is eradicated in these lymphomas before referral to standard treatment with chemotherapy and/or radiotherapy.
[Incidence and prevalence of symptomatic celiac disease among adults in Denmark]
Bode SH. Gudmand-Hoyer E.
Medicinsk afdeling F., Amtssygehuset i Gentofte.
The purpose was: 1) to determine annual incidence rates of adult coeliac disease, 2) to calculate the risk of having developed coeliac disease in adult life, and 3) to calculate the life time prevalence by five-year birth cohorts. All patients fulfilling defined criteria for adult coeliac disease living in the county of Copenhagen and diagnosed during the years 1976-1991 were included. The reference population consisted of 503,283 subjects. The overall incidence had been stable during the period, and was 1.27/10(5). The figures for females and males were 1.55/10(5) and 0.96/10(5), respectively (p = 0.04). The median (range) age at the time of diagnosis was 40.1 (16-81). Age specific incidence rates varied considerably, with the peak rate located in the middle-aged population. The incidence rates were influenced by age at diagnosis (p = 0.01) and sex (p = 0.04), but not by the year when diagnosed. For a subject aged 89 years, the risk was 0.88/1000. The overall prevalence was 45.9/10(5). In conclusion, this incidence/prevalence is one of the lowest reported, and is definitely lower than prevalences reported from our neighbouring Scandinavian countries. Nothing points to higher incidence rates being present in Danish adults to compensate for the previously demonstrated very low rates in Danish children.
Poerregaard A. Wewer AV. Becker PU. Bendtsen F. Krasilnikoff PA. Matzen P.
H:S Hvidovre Hospital, borneafdelingen og medicinsk gastroenterologisk afdeling.
The procedure and results of 50 colonoscopies performed over a three-year period on a group of 43 children (range: 0.3-16 yr; median: 9 yr) are described. The main indications were evaluation for, or control of already known, chronic inflammatory bowel disease (n = 38) and rectal bleeding (n = 8). Following verbal and written information the children were admitted one to two days before the procedure for bowel preparation. Children < 10 years old received general anaesthesia during the colonoscopy (n = 25) and most children > or = 10 years old received an intravenous sedation with pethidine and midazolam (n = 25). In only one case was intravenous sedation not successful. The coecum was visualised in 96% and the terminal ileum intubated in 77% (when intended) of the endoscopies. The most important results obtained were establishment of the diagnosis of inflammatory bowel disease in 21 of 30 suspected cases and the removal of a polyp in two cases. At the time of colonoscopy a "best guess" diagnosis of either ulcerative colitis or Crohn's disease often predicted the histological diagnosis, but endoscopy tended to underestimate the severity and extent of the inflammation as compared to microscopy. There were no complications. We conclude that colonoscopy performed according to our recommendations is a safe and informative procedure for evaluation of the large bowel and terminal ileum in children with intestinal disease.
[Pulmonary vasculitis as an extraintestinal manifestation in ulcerative coliltis]
Vesel HT. Eithz C.
Skive Sygehus, medicinsk afdeling.
Pulmonary complications are rarely reported in association with ulcerative colitis. Our patient had ulcerative colitis, diagnosed three decades earlier. Following a relapse of his ulcerative colitis, the patient developed bloodstained sputum. Chest CT-scan showed signs of pulmonary tissue infiltration indicating pulmonary vasculitis. No causative agent for this clinical condition was found. Testing for ANCA showed the vasculitis to most likely be secondary to his ulcerative colitis. The lung lesions responded to corticosteroid therapy within a week, and the following chest CT-scan was normal.
[Does colonic J-pouch after low anterior resection of rectal cancer give a better functional result?]
Okholm M. Christiansen J.
Kirurgisk afdeling D, Amtssygehuset i Herlev.
Low anterior resection (LAR) with mesorectal excision for adenocarcinoma of the rectum leads to low colorectal or coloanal anastomosis, and often poor functional results. Increased stool frequency and urge are common after the operation, and some have anal incontinence. Construction of a neo-rectum, in the form of a colonic J-pouch improves the functional results to some extent. Patients with a colonic J-pouch have significantly lower stool frequency and perhaps also fewer symptoms of urge and incontinence than patients with a straight coloanal anastomosis. If part of the rectum is preserved, the benefit of a pouch is doubtful. The overall quality of life after the operation in patients with a J-pouch is not different from quality of life in patients with a straight coloanal anastomosis. Patients with a pouch may have trouble emptying the reservoir, this is less pronounced if the pouch is shortened to 5 cm. It is not proved with certainty that patients with a colonic J-pouch have fewer anastomotic leakages than patients with a straight coloanal anastomosis. It is concluded that with an anastomotic height below 5 cm a pouch apparently improves the functional results after LAR for adenocarcinoma of the rectum, while the benefit of a pouch above this anastomotic height is doubtful.
[Anal and urinary incontinence after obstetric anal sphincter rupture]
Tetzschner T. Sorensen M. Lose G. Christiansen J.
Gynaekologisk-obstetrisk afdeling G, Amtssygehuset i Glostrup.
The aim of the study was to assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence, and identify factors to predict patients at risk. In 94 consecutive women who had sustained an obstetric anal sphincter rupture, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months post partum was performed. A questionnaire regarding incontinence was sent between two to four years post partum. Forty-two percent of responders had anal incontinence, 32% had urinary and anal incontinence. Overall, 56% of the women had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies > 2.0 milliseconds and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Thirty-eight percent of the women with incontinence wanted treatment, but only a few had sought medical advice.
[Effect of early postoperative enteral nutrition on postoperative infections]
Beier-Holgersen R. Boesby S.
Kirurgisk gastroenterologisk afdeling D2, Amtssygehuset i Glostrup.
We undertook this study to test the hypothesis that early enteral nutrition might reduce the incidence of serious complications after major abdominal surgery. In a randomized double blind prospective trial 30 patients received Nutridrink and 30 patients received placebo through a nasoduodenal feeding tube. On the day of operation the patients were given median 600 ml nutrition/placebo, 60 ml/h. On the first postoperative day the patients received median 1000 ml nutrition/placebo, second day median 1200 ml nutrition, 1400 ml placebo, third postoperative day median 1000 ml nutrition, 1150 ml placebo and 4th postoperative day median 1000 ml nutrition, 800 ml placebo. All patients were followed for 30 days by the same investigator. The two groups were not different with regard to nutritional status and type of operation. The rate of postoperative infectious complications was significantly lower in the nutrition group, 2/30 compared to 14/30 in the placebo group (p = 0.0009). We conclude that early enteral nutrition given to patients after major abdominal surgery is followed by a major reduction in infectious complications.
[Bile acid therapy vs. placebo before and after extracorporeal shock wave lithotripsy of gallbladder stones]
The aims of the project were to study the effects of bile acid therapy on the fragmentation rate of cholesterol gallbladder stones by extracorporeal shock wave lithotripsy (ESWL) and on the clearance of fragments after ESWL. One hundred and two patients with biliary pain, between one and five radiolucent gallbladder stones, and a gallbladder with a patent cystic duct were randomized to three weeks of double-blind treatment with bile acids (ursodeoxycholic acid 500 mg and chenodeoxycholic acid 500 mg per day) or placebo before ESWL. After successful fragmentation by ESWL (largest fragment (< or = 5 mm) the patients were re-randomized to six months double-blind therapy with bile acids or placebo. The endpoint of pre-ESWL bile acid/placebo therapy was the proportion of patients having a successful fragmentation after < or = 3 sessions of ESWL. After post-ESWL bile acid/placebo therapy success was defined as a gallbladder cleared of fragments. Ninety-nine patients carried out three weeks of pre-ESWL treatment. There was no statistically significant difference in fragmentation rate between the two groups. After six months of post-ESWL therapy, 12 of 49 patients (24%) receiving bile acids had cleared the fragments from their gallbladder compared to 5 out of 50 patients (10%) who received placebo (p = 0.10). There was no significant difference in the occurrence of pain between the two groups. In conclusion, ESWL with or without adjuvant bile acid does not seem to be an attractive therapy for patients with uncomplicated symptomatic gallstone disease.