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Biomedical subjects

H Harling

Publications and source records attributed to H Harling.

At least 55 records · Page 3Linked to original sources
PubMed1988

Paget's disease of the anal margin.

A follow-up study of 22 patients with Paget's disease of the anal margin was conducted to determine the prevalence of invasive disease and coexisting visceral carcinomas, cure and survival rates. Seventy-three per cent of the patients suffered from persistent pruritus ani. Seven (32 per cent) patients had malignancy (invasive Paget's disease (n = 5) and coexisting visceral carcinoma (n = 2] and six (27 per cent) developed malignancy (invasive Paget's disease (n = 4) and coexisting visceral carcinoma (n = 2] during follow-up, giving an overall occurrence of malignancies of 59 per cent (95 per cent confidence limits: 36-79). The median follow-up period was 9 (range 0.5-25) years. No difference in length of history could be found between patients with or without malignancy. The estimated cure rate by actuarial analysis among radically treated patients was 64 per cent (95 per cent confidence limits: 43-91) at 1 year and 45 per cent (95 per cent confidence limits: 18-72) at 8 years after primary treatment. The 5- and 10-year crude survival rates of 54 per cent and 45 per cent, respectively, were significantly lower than the corresponding values of 84 per cent and 60 per cent for the normal population (P less than 0.01). Patients with persistent pruritus ani and a perianal skin lesion should be biopsied frequently. If Paget's disease is diagnosed, physical examination of the patient and anorectal region must be done carefully and repeatedly.

Aged↗
PubMed1988

Adenocarcinoma of the anal ducts. A series of 21 cases.

The records of 21 patients treated for adenocarcinoma of the anal ducts between 1943 and 1982 were reviewed. The patients were followed until death or current status in April 1987. The median follow-up period was eight months (range, 3 to 144 months). Fifteen patients had an erroneous diagnosis made at first physician visit resulting in a median doctor's delay of 14 months (range, 3 to 24 months) before correct treatment was carried out. Nine of the tumors were localized perianally (ischiorectal space), seven anally, and five in a fistula-in-ano. Tumors localized anally were significantly smaller and had a significantly shorter history than perianally or fistula-in-ano localized tumors (P less than .05 for each localization). Three patients with anal tumors had their diagnosis made accidentally by routine histologic examination of an excised hemorrhoid. First examination revealed distant metastases in 13 patients and follow-up examination revealed regional or distant metastases in seven patients. Modes of treatment were wide local excision (N = 3), abdominoperineal resection (N = 3), colostomy (N = 9), and radiotherapy (N = 2). Twenty of the 21 patients died within 18 months due to the cancer. One long-term survivor was observed; the patient was alive 12 years after local excision of the tumor without evidence of recurrent disease. The crude five- and 10-year survival was only 4.8 percent.

Adenocarcinoma↗
PubMed1988

Long-term prognosis after radical treatment for squamous-cell carcinoma of the anal canal and anal margin.

Sixty-seven of 100 (67 percent) and 24 of 58 (41 percent) apparently radically treated patients with squamous-cell carcinoma of the anal canal (AC) and the anal margin (AM) developed recurrent disease during a median observation time of ten years (range, 0 to 38 years). A significantly higher number of patients treated for AC tumors with local excision had recurrent disease compared with patients treated with abdominoperineal resection (P less than .05). Twenty patients with AC tumors had local recurrence, 21 regional recurrence, and 26 visceral metastases. Eighteen patients with AM tumors had local recurrence, five regional, and one brain metastases. The latest recurrences among AC and AM tumor patients were diagnosed 11 and nine years after primary treatment, respectively. The estimated cure rate by the actuarial method after 15 years was 26 percent and 53 percent for AC and AM tumors, respectively. Thus, if recurrent carcinomas of the anus are to be detected early, frequent life-long control examinations are necessary. It is obvious from this study that, in order to reduce recurrent disease of carcinoma of the anus, new treatment regimens must be tried under controlled circumstances. Surgical therapies alone are clearly insufficient in the treatment of carcinoma of the anus.

Actuarial Analysis↗
PubMed1988

Long-term prognosis of patients with severe radiation enteritis.

One hundred thirty-six patients (median age 59 years) presented with intestinal complications of previous radiotherapy. Seventy-eight had bleeding or stricture and 58 had perforation or fistula. One hundred twenty-four patients survived for more than 3 months and were followed for a median of 4.5 years. Sixty-eight patients were free of symptoms, whereas 16 experienced operation-related complications. Twelve patients had continuing symptoms of radiation enteritis, and new radiation-induced complications developed in 28. Sixteen of 51 patients with perforation or fistula had new complications compared with 12 of 73 patients with bleeding of stricture (p = 0.05). Overall, 57 patients died during the study. Thirteen died from radiation-induced complications and 27, from recurrent malignancy. Radiation deaths occurred in the postoperative period but had no impact on long-term survival. Life expectancy was poorer in patients presenting with perforation or fistula compared with bleeding or stricture, the main reason being significantly more recurrences among patients with fistulas (p less than 0.05).

Adult↗
PubMed1987

"Femoro-distal bypass--a worthwhile procedure?".

Infrapopliteal vascular reconstruction was undertaken in 63 patients with limb threatening ischaemia. Graft materials used were reversed autogenous saphenous vein in 33 patients, umbilical vein in 23 patients, composites of saphenous and umbilical vein in six patients, and a Solcograft in one patient. At the end of the first month 13 grafts were non-functioning, and eight of these patients had an amputation performed. Cumulative 3-year limb salvage and patency rates were 69% and 35%, respectively. Cumulative patency rates of saphenous and umbilical vein grafts were equal, and neither the indication for operation nor the preoperative ankle-arm pressure index correlated to graft failure. In total, twenty-two major amputations were performed, 16 below or through the knee, and six above-knee. The conclusion is that vascular reconstructive surgery for limb threatening distal disease is a valuable procedure.

Arterial Occlusive Diseases↗
PubMed1986

Radical surgical approach to radiation injury of the small bowel.

During a period of 12 years, 52 patients without tumor recurrence were treated for chronic radiation injury to the small bowel. Eighteen patients also had concomitant large bowel injuries. Forty-seven patients were treated surgically, 42 of whom presented with obstruction, necrosis, or perforation of the bowel and had emergency operations. Thirty-eight patients underwent wide resection of the injured bowel, and six had bypass procedures. Anastomotic leakage occurred in 6 percent of the patients. The operative morbidity rate was 34 percent, and the mortality rate, 9 percent. Based on this experience, when surgery for small intestinal radiation injury is mandatory, the procedure should be a generous small bowel resection whenever possible, and probably should be performed only by experienced surgeons.

Abdominal Neoplasms↗
PubMed1986

Primary malignant ovarian carcinoid.

A case of a primary ovarian carcinoid arising in the right ovary of a 17-year-old female is reported. The microscopic picture was very heterogeneous and there was heavily metastatic involvement of the liver but no symptoms of the carcinoid syndrome. No response to DTIC as part of combination chemotherapy was achieved.

Adolescent↗
PubMed1986

Surgical treatment of radiation injury to the rectosigmoid.

Radiation-induced injury to the rectosigmoid, the estimated incidence of which was 5.5%, was studied in 92 patients. The condition was surgically treated in 75 cases. Colostomy alone was undertaken in 40 patients, 37 of whom were greatly improved with no need for further surgery, while two had progression of rectal radiation damage and one died. Excisional surgery was performed in 35 cases--Hartmann procedure in 25 and resection with primary anastomosis in 10 cases. Five of these 35 patients died of operative complications. Of the total 16 colonic anastomoses, four leaked. Our impression is that a differentiated policy of proximal colostomy and intestinal resection is safe and effective, although a significant number of the patients will have a permanent colostomy.

Adult↗
PubMed1985

Parietal cell vagotomy or cimetidine maintenance therapy for duodenal ulcer? A prospective controlled trial.

In a prospective controlled trial 86 duodenal ulcer patients with symptoms severe enough to indicate surgery were randomized to a full-dose cimetidine course followed by maintenance therapy for 1 year or parietal cell vagotomy (PCV). The average follow-up period was 57 months. In the group assigned to medical therapy 62% of the patients were free of symptoms during maintenance therapy, and 12% remained well during the follow-up period. Operation was later performed in 35%, whereas 53% had symptomatic recurrence demanding medical treatment regularly. After PCV no patient died, and there were no serious sequelae. The overall recurrence rate was 17%; after treatment of failures 9% continued to have dyspepsia. Since nearly 3/4 of the patients were free of symptoms after PCV, operation seems to be the method of choice in patients with a severe history and fast recurrence after medical therapy. However, the aged and those at high risk of surgery may benefit from cimetidine maintenance therapy.

Adult↗
PubMed1985

Primary non-specific ulcer of the small bowel.

A case is presented of lifelong bleeding from an ileal ulcer in a 17-year-old female. This diagnostic possibility should be suspected in gastrointestinal hemorrhage when no commoner localization of the bleeding can be found.

Adolescent↗
PubMed1984

"Spontaneous rupture of the stomach". A case report.

Spontaneous rupture of the stomach is a rare condition with a high lethality. Two cases of a previously undescribed aetiology are reported. One rupture occurred because of a bleeding ulcer in combination with a nonfunctioning Sengstaken's tube and the other because of cancer pancreatis occluding the duodenum. Aetiology, pathogenesis and clinical course of spontaneous rupture of the stomach is shortly discussed together with a brief review of the literature.

Aged↗