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Biomedical subjects

E Carlsen

Publications and source records attributed to E Carlsen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Loop ileostomy: technical aspects and complications.

OBJECTIVE: To study the incidence of complications of construction and closure of loop ileostomies and the final outcome for the patients. DESIGN: Retrospective study. SETTING: University hospital, Norway. SUBJECTS: 100 patients with 103 loop ileostomies, operated on between 1980 and 1990. MAIN OUTCOME MEASURES: Number of complications after ileostomy construction and closure. RESULTS: 7 required re-operation after construction of the loop ileostomy and 11 after its closure. The most common cause was small intestinal obstruction (4 after construction and 6 after closure). 2 developed stomal necrosis. The mean duration of hospital stay was 13 and 10 days for primary and secondary loop ileostomy, respectively, and the mean time before closure was 31 weeks. After closure another 6 developed leaks from the ileal anastomosis that required further operation. Patients with secondary loop ileostomies had their stomas significantly longer than those with primary loop ileostomies (21 compared with 43 weeks, p = 0.00005). CONCLUSION: Despite the number of complications, we think that faecal diversion is still justified in complex pelvic surgery and we should try to reduce the complication rate further.

Adenomatous Polyposis Coli↗
PubMed1999

Diurnal rhythm in serum levels of inhibin B in normal men: relation to testicular steroids and gonadotropins.

Inhibin B is a testicular glycoprotein that is secreted from the Sertoli cells and believed to play a role in FSH secretion. We characterized the diurnal profile of serum inhibin B and the relation to gonadotropins and testicular steroids. Serum inhibin B was measured in 13 healthy normal male volunteers (median age, 30 yr) by continuous blood drawing, with sampling every 30 min for 24 h. Blood samples were also analyzed for FSH, LH, testosterone, estradiol, and sex hormone-binding globulin. We found a significant diurnal variation in inhibin B, with peak values in the early morning and nadirs in the late afternoon, followed by gradual increasing nocturnal values. An average decline of 3%/h from 0900 until 1700 h was calculated. Significant cross-correlation was found between inhibin B and testosterone as well as estradiol, whereas no cross-correlation was found between inhibin B and FSH. Two-dimensional time-series analyses revealed a statistically significant influence of testosterone on inhibin B. In addition, estradiol and inhibin B had a significant influence on one another. In conclusion, we found a significant diurnal variation in inhibin B levels in normal men, with a pattern of higher values in the early morning hours and lower values in the late afternoon and evening. We did not find evidence for a role of FSH in this diurnal variation of inhibin B. However, covariation with serum levels of testosterone and estradiol suggested that these hormones might play a role in the diurnal rhythm of inhibin B, although some other common influence could not be excluded.

Adult↗
PubMed1998

[Introduction of a new surgical technique in rectal cancer].

Local recurrence rates following surgery for rectal cancer show considerable variation in different series, but impressive results (< 4% local recurrences after five years) have been presented by surgeons using total mesorectal excision as their operative technique. In Norway, local recurrence rates of 30% have been reported. Total mesorectal excision was introduced at Ullevaal Hospital in January, 1994 following a specific training programme. To enable us to compare the results, we followed-up two groups of patients who had undergone surgery for rectal carcinoma; one group (76 patients) before the introduction of total mesorectal excision and the other (76 patients) after total mesorectal excision was introduced. Anastomotic leakages were the main problem in the initial phase, but after faecal diversion became routine only one leakage was observed. After a median observation time of 28 months we had observed two patients (4.3%) with local recurrence in the total mesorectal excision group, and ten (23.8%) in the group where total mesorectal excision had not been performed.

Adult↗
PubMed1998

Mesorectal excision for rectal cancer: a view from Europe.

The local recurrence rate after rectal cancer surgery is discussed as related to conventional and total mesorectal excision (TME) techniques. Studies now show that the wide variation in results between centers and among surgeons depends, at least in part, on differences in surgical technique. We conclude that local tumor recurrence rate is lower after TME than after conventional surgery and emphasize the importance of a standardized macroscopic evaluation of the resected specimen. Population-based registration to evaluate the quality of surgery is recommended. It is also suggested that randomized studies on adjuvant treatment for rectal cancer should include a "surgery only" arm when a local tumor recurrence rate of 10% or less is being studied. Until such investigations are performed, we conclude that the role for adjuvant treatment is questionable and that TME surgery is preferred as the treatment option for Stage T1-T3 rectal cancers.

Europe↗
PubMed1998

Effect of the introduction of total mesorectal excision for the treatment of rectal cancer.

BACKGROUND: Total mesorectal excision (TME) has been reported to reduce local recurrence and improve survival rates in patients with rectal carcinoma. This paper reports the problems that have arisen with the introduction of this new surgical technique. METHODS: This was a prospective study of two consecutive groups of patients: one who underwent TME (n = 76) and one who did not (non-TME, n = 76). RESULTS: Postoperative mortality rate in the non-TME and TME group was 5 and 7 per cent respectively, and the rate of anastomotic failure was 8 and 16 per cent respectively. Anastomotic leaks in TME patients were located in the mid and lower rectum. TME patients with anastomotic failure had lower anastomoses and a longer duration of operation than non-TME patients. Intraoperative problems were encountered in 71 per cent of the failures. All TME patients who had a leak required reoperation compared with 25 per cent of non-TME patients. TME patients without postoperative complications stayed significantly longer in hospital than non-TME patients. CONCLUSION: Anastomotic dehiscence increased after introduction of the TME technique but this improved with experience.

Adult↗
PubMed1998

Germ cell cancer and disorders of spermatogenesis: an environmental connection?

Why is there a small peak of germ cell tumours in the postnatal period and a major peak in young age, starting at puberty? And, paradoxically, small risk in old age, although spermatogenesis is a lifelong process? Why is this type of cancer more common in individuals with maldeveloped gonads, including undescended testis, gonadal dysgenesis and androgen insensitivity syndrome? Why has there, during the past 50 years, been a quite dramatic increase in testicular cancer in many developed countries? These are just a few of many questions concerning testicular cancer. However, the recent progress in research in the early stages of testicular cancer (carcinoma in situ testis (CIS)) allows us to begin to answer some of these questions. There is more and more evidence that the CIS cell is a gonocyte with stem cell potential, which explains why an adult man can develop a non-seminoma, which is a neoplastic caricature of embryonic growth. We consider the possibility that CIS cells may loose their stem cell potential with ageing. Along these lines, a seminoma is regarded a gonocytoma where the single gonocytes have little or no stem cell potential. The Sertoli and Leydig cells, which are activated postnatally and during and after puberty, may play a crucial role for both the development of the CIS gonocyte and progression of the neoplasm to invasiveness. The reported increase in testicular cancer is not the only sign that male reproductive health is at risk. There are reports that undescended testis and hypospadias have become more common. Also semen quality has deteriorated, at least in some countries. The epidemiological evidence suggests that environmental factors may play a role. Are the environmental hormone disrupters (e.g. DDT, PCB, nonylphenol, bisphenol A) to be blamed for the apparently synchronised deterioration in these aspects of male reproductive health?

Adult↗
PubMed1996

[Diagnosis and treatment of gastrointestinal hemorrhage].

The handling of gastrointestinal bleeding was discussed at a national expert symposium in February 1995. Internists are in charge of therapeutic endoscopy of upper gastrointestinal bleeding at the majority of Norwegian hospitals, but close collaboration with the surgeon on call is vital. The need for intensive care and monitoring may have been underestimated, since decompensation of co-existing diseases is a more frequent cause of death than the haemorrhage itself. Endoscopic treatment is the primary choice in all parts of the gut where endoscopy is possible, but surgery must be considered for patients who rebleed. Injection of sclerosering agents is the most prevalent mode of treatment for oesophageal varices and ulcers, but thermal probes and rubber band ligation are probably equally effective in experienced hands. Major lower bowel haemorrhage can render colonoscopy impossible, and emergency resections may be warranted, but preferably after angiography or peroperative endoscopic localisation of the area of bleeding.

Acute Disease↗
PubMed1996

[Administrative handling of gastrointestinal hemorrhage in Norway].

Rapid and adequate endoscopic treatment is a vital part of the initial handling of gastrointestinal haemorrhage. A national survey was carried out to study the logistics of the initial handling of these patients. Replies were received from 97% of the hospitals, each of which received an average of 11 patients per month with haematemesis/melena or rectal bleeding. Patients with haematemesis or melena were admitted primarily to medical departments or intensive care units, while patients with haematochezia were admitted most often to the surgical department. 47% of the hospitals performed emergency endoscopy as a routine on patients with red haematemesis, but even in this group of patients, endoscopy was postponed until the first working day in some instances, provided that the patient's condition was stable. The majority of emergency flexible endoscopies are performed by internists, but most hospitals describe close inter-departmental cooperation in the handling of these patients. The situation was deemed satisfactory at 91% of the hospitals.

Emergency Service, Hospital↗
PubMed1996

Reproductive history and cigarette smoking as risk factors for thyroid cancer in women: a population-based case-control study.

A population-based case-control study was conducted in Northern Norway and Central Sweden to investigate hormonal and reproductive factors and cigarette smoking as determinants of papillary and follicular thyroid carcinoma in women. Information on 191 histologically confirmed cases and 341 age-matched controls was included. No clear association was found with regard to the number of live births, number of pregnancies, a history of incomplete pregnancies, or the use of oral contraceptives or hormonal replacement therapy. However, an early first childbirth (before 20 years of age, or less than 5 years after menarche) was associated with an increased risk of thyroid cancer. There was an increased risk of thyroid cancer among women with a history of artificial menopause compared to those with a spontaneous menopause [odds ratio (OR), 2.52; 95% confidence interval (CI), 0.96-6.62], which was more pronounced for the papillary carcinoma and after adjustment for age at menopause and use of replacement therapy. Cigarette smokers had a decreased risk of borderline statistical significance compared to nonsmokers (OR, 0.69; 95% CI, 0.47-1.01), particularly among premenopausal women (OR, 0.60; 95% CI, 0.38-0.96). This negative association persisted after adjustment for parity, hormonal treatments, and education. Women who started smoking before the age of 15 experienced a marked reduction in risk (OR, 0.38%; 95% CI, 0.18-0.80¿). Moreover, there was a suggestion of a dose-response effect with the amount of cigarettes smoked daily and with duration of the habit. Both the increased risk of artificial menopause and the negative association with smoking are compatible with a relation between levels of estrogens and thyroid cancer among women.

Adenocarcinoma, Follicular↗
PubMed1995

Declining semen quality and increasing incidence of testicular cancer: is there a common cause?

Male reproduction has been given little attention in science and in medical practice. However, a recent metaanalysis on semen quality, which clearly pointed to a decrease over the past 50 years, has been repeatedly quoted. Three recent reports have found that semen quality has declined among candidate semen donors during the past 20 years. The evidence of decline in the quality of semen is not the only indicator that the human testis is at risk. During the past 50 years, cancer of the testis has also become more common. This is a disorder of young men, and it is associated with a high rate of other abnormalities of the testis including undescended testis and poor semen quality. Furthermore, the incidence of both hypospadias and undescended testis has been reported to be rising in the general population. We believe that the evidence of declining semen quality should be seen in the light of these trends in other reproductive disorders of men. However, the etiology is unknown. A recent hypothesis that links the trends in the health of the male reproductive system to xenoestrogens in the environment is discussed.

Adult↗
PubMed1993

[Decline in semen quality from 1930 to 1991].

It has been suspected for years that semen quality has declined. However, the issue is still controversial since previous studies were criticized for methodological errors. We therefore attempted to systematically review the complete international literature on semen quality since 1930 with rigorous selection criteria and statistical analysis. Based on a literature search using Cumulated Index Medicus and Current List (1930-1965) and MEDLINE Silver Platter database (1966-august 1991), we identified 61 papers concerning sperm density in a total of 14,957 males without a history of infertility. A significant decline in mean sperm density from 113 x 10(6)/ml in 1940 to 66 x 10(6)/ml in 1990 (p < 0.0001) and in mean seminal volume from 3.40 ml to 2.75 ml (p = 0.027) was noted. The incidence of testis cancer and possibly also that of cryptorchidism and hypospadias has increased during the same relatively short time period. Such a remarkable deterioration in male genitourinary function is more likely to be due to environmental rather than genetic factors.

Global Health↗
PubMed1993

[Extracerebral metastases from cerebral glioblastoma].

A patient with glioblastoma multiforme in the right cerebral hemisphere had extracranial metastases, probably mediated via a ventriculoperitoneal shunt. Extracranial spread of malignant tumours of the central nervous system is very rare. We point out the possibility of metastases in patients who have undergone craniotomy or who have a systemic shunt. We discuss other possible ways of spreading, prophylactic measures, and the various modalities of treatment for these metastases.

Adult↗
PubMed1993

Ultrasonic testicular texture and size in 444 men from the general population: correlation to semen quality.

Scrotal ultrasonography was performed in 888 testes of 444 randomly selected men appearing before the medical board prior to military service (Mili group, 287 men, median age 18.8 years), and in employees from an industrial company (Empl group, 157 men, median age 35.6 years). The ultrasonic volume of each testis was calculated from 3 perpendicular measurements. The ultrasonic texture on sectional planes was scored using a scale from 1 to 5, 1 being very regular, 2 slightly irregular, 3 moderately irregular, 4 very irregular or with bright echogenic points, and 5 with demarcated tumor suspicious areas. Orchidometer measurements were performed in 258 men in Mili group, and semen samples were obtained from 121 men in Empl group. The ultrasonic volume of the right testis (median 14.1 ml, range 3.0-31.4 ml) was bigger than that of the left testis (median 13.0 ml, range 3.5-35.2). The volume was dependent on age for men under 20 years, but not for men aged 20 years or more. The subgroup of men with a history of cryptorchidism had a smaller average testicular volume (median 10.5 ml) compared with men with normal descent (median 14.1 ml). Ultrasonic volume was positively correlated to the total sperm count in the ejaculate, to sperm penetration in egg white, and to normal sperm morphology. The echo score distribution showed slightly higher scores in Empl for both the right and the left testis. Men in Empl group were older, and it could not be precluded that this difference was due to age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗