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Biomedical subjects

J Christiansen

Publications and source records attributed to J Christiansen.

At least 91 records · Page 5Linked to original sources
PubMed1996

Endosonography for preoperative staging of rectal tumours.

PURPOSE: The aim of this study was to evaluate the use of rectal endosonography for preoperative staging of tumour extension and lymph node involvement in rectal tumours. MATERIAL AND METHODS: Over a 4-year period 100 patients with rectal tumours were studied with sonography using 7 MHz endoprobes. Tumour spread was assessed according to the TNM classification, and the number and maximum size of perirectal lymph nodes were registered. The sonographic findings were compared with the surgical and histological findings. RESULTS: The overall accuracy of endosonography in assessing local tumour extension was 85% (76-91%; 95 percent confidence limits). T4 tumours with a large contact surface to an adjacent organ tended to be nonresectable. Lymph node assessment could be made in 81 patients who underwent radical resection: sonography showed lymph nodes in 49 patients, 30 of whom had nodal metastases; the histological examination showed lymph nodes in the remaining 32 patients, 8 of whom had nodal metastases. The number of lymph nodes at the histological examination was markedly higher than the number depicted by preoperative ultrasound. CONCLUSION: This study confirmed the use of endoluminal ultrasound in the preoperative evaluation of local tumour spread. However, endosonographic assessment of perirectal nodal involvement seems to be too unreliable to be used for the preoperative selection of patients.

Adenocarcinoma↗
PubMed1996

Laparoscopic-assisted ileocecal resection for Crohn's disease: a preliminary study.

BACKGROUND: The aim of the study was to present our preliminary results with laparoscopic-assisted ileocecal resection in Crohn's disease of the terminal ileum. METHODS: Eight patients were operated on. The operations were assessed with regard to duration of operation, rate of conversion to open procedure, complications, time for discharge from hospital, and ability to take up work. RESULTS: Median operation time was 145 min. One operation (12.5%) was converted to open procedure. Minor complications occurred in one patient (12.5%). Median postoperative time for discharge was 5 days. Median time to return to work was 21 days. CONCLUSIONS: Laparoscopic-assisted ileocecal resection seems suited to Crohn's disease, but the benefit of the method needs confirmation in controlled, randomized studies.

Adolescent↗
PubMed1996

Colectomy for severe slow-transit constipation in strictly selected patients.

BACKGROUND: Colectomy for severe constipation has in up to 25% of patients given unsatisfactory results. Failure to cure constipation is in most patients due to rectal dysfunction. The aim of the present study was to evaluate the effect of colectomy in a group of patients who fulfil all the criteria which, with our present knowledge, should predict a favourable result. METHODS: Twelve patients with long-standing severe constipation incurable by dietary regulation and medical treatment with demonstrable slow-transit constipation and normal rectal function entered the study. RESULTS: Ten patients were relieved of their constipation. Two patients continued to be constipated after subtotal colectomy. One had a very highly compliant rectum (preoperatively) with a maximal tolerable volume of 700 ml but normal emptying at defecography and normal emptying of viscous fluid. The patient was subsequently treated with proctectomy and ileo-pouch-anal anastomosis with satisfactory result. One patient with opioid abuse due to abdominal pain was improved by the operation but was still constipated. The opioid abuse continued, however, after the operation owing to continuing abdominal pain. A further three patients complained of abdominal pain, and two developed diarrhoea, one of whom became incontinent. CONCLUSION: Subtotal or segmental colectomy should be considered in a small number of patients with severe constipation provided strict criteria are fulfilled. Excessively high rectal volume tolerability may in spite of normal emptying capacity indicate the risk of development of rectal inertia postoperatively and may be a contraindication for surgery.

Adult↗
PubMed1996

Physiology and pathophysiology of anal function.

A review of the Danish contributions to the increased understanding of anorectal physiology and pathophysiology during the last 25 years is presented. In this period there has been a vast international increase in interest in anorectal physiology and pathophysiology, with much improvement in the understanding and treatment of anorectal functional disorders. The application of new sophisticated techniques to anorectal physiology research continues to improve our knowledge of anorectal function.

Anal Canal↗
PubMed1996

Prognostic model for patients treated for colorectal adenomas with regard to development of recurrent adenomas and carcinoma.

OBJECTIVE: To quantify the risk of developing recurrent adenomas or colorectal cancer for patients who had already had colorectal adenomas removed. DESIGN: Retrospective study. SETTING: University hospital, Denmark. SUBJECTS: 479 patients who had colorectal adenomas removed between 1958-80. INTERVENTIONS: All patients were followed up by rectoscopy and double contrast barium enema. The survival data were analysed by Cox's proportional hazards model. MAIN OUTCOME MEASURES: Variables of significant prognostic importance for recurrence of adenomas and the development of cancer were identified. Results. For the long term risk of recurrence of the adenoma (more than 1.5 years after removal of the first adenoma), two variables were of prognostic significance: The occurrence of synchronous adenomas or recurrent adenomas, and the sex of the patient. The model for development of colorectal cancer identified two variables of prognostic significance: the grade of dysplasia and the size of the first adenoma. CONCLUSION: We suggest that these variables can be used in the management of patients with adenomas, particularly in developing individual follow-up regimens.

Adenoma↗
PubMed1995

Growth-dependent translation of IGF-II mRNA by a rapamycin-sensitive pathway.

Insulin-like growth factor (IGF)-II is important for fetal growth and development. The human IGF-II gene generates multiple mature transcripts with different 5' untranslated regions (5'UTRs) but identical coding regions and 3'UTRs. We have previously shown that a minor 4.8-kilobase messenger RNA was engaged in the synthesis of preproIGF-II, and a major 6.0-kb mRNA was untranslated and stored in a 100S ribonucleoprotein particle. Here we demonstrate that the 6.0-kb mRNA is selectively mobilized and translated in dispersed exponentially growing cells. Translational activation is prevented by rapamycin and mimicked by anisomycin, which suggests that translation of the 6.0-kb mRNA is regulated by the p70S6k/85S6k kinase signalling pathway. Therefore, the minor 4.8-kb mRNA generates a constitutive production of prepro-IGF-II, whereas the major 6.0-kb mRNA provides a post-transcriptionally regulated species.

Anisomycin↗
PubMed1995

DNA analysis of in situ ductal carcinoma of the breast via flow cytometry.

Flow cytometric (FCM) DNA analysis of 41 clinical cases of ductal carcinoma in situ (DCIS) of the breast was performed on fine-needle aspirates of unfixed, frozen tissue. Based on analysis of a single tissue sample, abnormal DNA content was found in 35 (85%) of the cases, and 15 (37%) disclosed heterogeneity. If five or more samples were analyzed, then heterogeneity was found in eight of ten cases. No conclusive correlation could be found between DNA index (DI) and histopathology. Our results on DCIS demonstrate a very high concordance with invasive breast cancer with respect to the frequency of DNA nondiploid cases, distribution of DI, occurrence of multiple clones, and S-phase fraction. This indicates that major genetic alterations and DNA heterogeneity are early events in carcinogenesis that are already established at the preinvasive stage.

Breast Neoplasms↗
PubMed1995

Bilateral gluteus maximus transposition for anal incontinence.

Seven patients (five women and two men) with anal incontinence in whom previous surgery had failed, were treated by bilateral gluteus maximus transposition. All patients were incontinent to solid stool. Previous surgery was postanal repair in four women and secondary overlapping suture for obstetric tear in one. The two men were treated in childhood for anal atresia. No covering stoma was used. Wound infection occurred in three patients, requiring surgical drainage in two. After follow-up of more than 1 year three patients experienced improved continence but in four continence was unchanged. Anorectal physiology studies showed moderately increased resting and squeeze pressures in patients who were improved by the operation, but none could retain more than 200 ml of viscous fluid instilled into the rectum. No change in rectal sensitivity or volume tolerance was found. This preliminary series does not indicate that better results are obtained by gluteus maximus transposition than by unstimulated graciloplasty.

Adult↗
PubMed1995

Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction.

Fourteen patients with recurrent high anal fistula were treated by total excision of the fistulous tract with primary sphincter reconstruction. Nine patients with sepsis had seton drainage for one to three months before the operation. The surgical approach was the transsphincteric technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the stoma closed 3 to 5 months later. After a follow-up from 1 to 4 years two patients had recurrence, which in one necessitated a diverting ileostomy. Three patients, one with recurrence and two without, suffered from minor anal incontinence. It is concluded that total excision with primary sphincter reconstruction is a treatment modality which should be considered for recurrent high anal fistula, especially in patients where closure by an advancement flap is not possible.

Adult↗
PubMed1995

Effect of rectal dilation in fecal incontinence with low rectal compliance. Report of a case.

PURPOSE: This study was undertaken to determine the effect of rectal dilation in a patient with urge-type fecal incontinence and frequent bowel movements associated with low rectal compliance and capacity. METHOD: Daily rectal balloon dilation was performed for a period of four weeks. RESULTS: The patient regained complete fecal continence with one to two daily bowel movements. Rectal compliance, capacity, and cross-sectional area increased by 37 to 136 percent. Nine months later the patient was still without symptoms. CONCLUSION: Rectal balloon dilation may be a therapeutic alternative in selected patients.

Aged↗
PubMed1995

Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer.

PURPOSE: This study was designed to analyze factors of importance for local recurrence after radical surgery for rectal cancer and to analyze course and outcome of treatment of pelvic recurrence. METHODS: One hundred seventy-five patients treated for rectal cancer with low anterior resection (LAR) or abdominoperineal resection (APR) were studied, retrospectively. Seventy-four patients had LAR and 101 had APR. RESULTS: The two groups were comparable with respect to Dukes classification, histologic differentiation, and male to female ratio. The rate of pelvic recurrence was 18 percent for LAR and 24 percent for APR (not significant). Recurrence rates were 27 percent after stapled anastomoses and 10 percent after handsewn anastomoses respectively (P = 0.09). Twenty five had pelvic recurrence diagnosed without signs of distant metastatic disease. They were treated with radiotherapy, palliative operations, or analgesics. The group receiving radiotherapy had a significantly longer survival (15.9 months) compared with other groups (2.4 months; P < 0.001). CONCLUSIONS: There is no difference in local recurrence rate after LAR and APR. Radiotherapy seems to increase survival in patients with an unresectable recurrence and should be offered irrespective of pain.

Abdomen↗
PubMed1995

Observer variability in the assessment of type and dysplasia of colorectal adenomas, analyzed using kappa statistics.

PURPOSE: The aim of this study was to establish the intraobserver and interobserver variability in the assessment of histologic type (tubular, villous, and tubulovillous) and grade of cytologic dysplasia (mild, moderate, and severe) in colorectal adenomas. METHODS: One hundred eighty-seven slides of adenomas were assessed twice by three experienced pathologists, with an interval of two months. Results were analyzed using kappa statistics. RESULTS: For agreement between first and second assessment (both type and grade of dysplasia), kappa values for the three specialists were 0.5345, 0.9022, and 0.4100, respectively. Agreement was better for type than for dysplasia. The strength of agreement was moderate for Observers A and C and almost perfect for Observer B. Agreement between all three observers was seen in 35.2 percent for both type and dysplasia in 61 percent for type and in 47.8 percent for dysplasia. The kappa values for Observer A vs. B and Observer C vs. B were 0.3480 and 0.3770, respectively (both type and dysplasia). Values for type were better than for dysplasia, but agreement was only fair to moderate. CONCLUSION: The interobserver agreement was moderate to almost perfect, but the intraobserver agreement was only fair to moderate. A simpler classification system or a centralization of assessments would probably increase kappa values.

Adenoma↗
PubMed1995

Rectal compliance determined by rectal endosonography. A new application of endosonography.

PURPOSE: The aim of this study was to develop a method for determination of rectal compliance that allows direct measurement of corresponding changes in the rectal cross-sectional area or perimeter and rectal pressure. METHODS: We developed an anal probe for transrectal endosonography. The probe was tested in vitro, and rectal compliance of six healthy patients was determined. RESULTS: In vitro measurements proved the method to be well reproducible. The method allowed calculation of an endosonographic rectal compliance, which correlated well with rectal compliance measured by the standard method. CONCLUSION: Endosonographic determination of rectal compliance is possible, and the endosonographic method may give a more precise and reproducible estimation of rectal compliance.

Adult↗
PubMed1995

The Sry-related gene Sox9 is expressed during chondrogenesis in mouse embryos.

Mutations in the human SRY-related gene, SOX9, located on chromosome 17, have recently been associated with the sex reversal and skeletal dysmorphology syndrome, campomelic dysplasia. In order to clarify the role of this gene in skeletal development, we have studied the expression of mouse Sox9 during embryogenesis. Sox9 is expressed predominantly in mesenchymal condensations throughout the embryo before and during the deposition of cartilage, consistent with a primary role in skeletal formation. Interspecific backcross mapping has localized mouse Sox9 to distal chromosome 11. The expression pattern and chromosomal location of Sox9 suggest that it may be the gene defective in the mouse skeletal mutant Tail-short, a potential animal model for campomelic dysplasia.

Amino Acid Sequence↗
PubMed1995

Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth.

AIM: To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. METHODS: Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency. RESULTS: Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function. CONCLUSION: The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

Adolescent↗
PubMed1995

Treatment of internal rectal intussusception in patients with chronic constipation.

BACKGROUND: The significance of internal rectal intussusception (rectal invagination) in chronic constipation dominated by symptoms of obstructed defecation is not fully clarified. METHODS: Seventeen consecutive patients with chronic constipation and a history of obstructed defecation with internal rectal intussusception demonstrated by defecography were treated by perineal rectopexy. RESULTS: Of 15 patients followed up for more than 2 years defecography showed total disappearance of the intussusception in 12. Five of these claimed substantial improvement (42%; 17-72%). Three of four patients with concomitant anal incontinence became fully or partly continent after the rectopexy. CONCLUSION: In some patients with chronic constipation, dominated by symptoms of obstructed defecation, rectal invagination may be an aggravating factor. The study indicates that rectal invagination does not seem to be the cause but rather a consequence of the obstructed defecation. In selected patients, including those with concomitant faecal incontinence, surgical treatment of the intussusception by a minor procedure may be indicated.

Constipation↗
PubMed1995

Posttranscriptional regulation of insulin-like growth factor II mRNA.

The insulin-like growth factor II (IGF-II) gene generates multiple mature transcripts with different 5' untranslated regions (5'UTR) but identical coding regions and 3'UTRs. We have analysed the translational regulation and decay of the transcripts. Human IGF-II mRNAs provide a provocative example of translational discrimination in which only the minor 4.8 kb mRNA is actively engaged in protein synthesis while the major 6.0 kb mRNA is present in a 100S RNP particle. The 6.0 kb mRNA exhibits a structured 5'UTR of 1170 nucleotides that function as a cis-acting translational attenuator. IGF-II transcripts are processed by endonucleolytic cleavage 1209 and 2183 nucleotides downstream from the translation termination codons in the rat and human, respectively. The cleavage site is situated in a highly conserved and structured domain that exhibits two large hairpins and an intramolecular guanosine quadruplex. The structural elements may provide binding sites for trans-acting factors and ensure that the cleavage site is not sequestered in stable RNA structures. Since expression of IGF-II is initiated from minimal promoters and finished by constitutive secretion from the cell, regulatory events governing IGF-II production are likely to be implemented between the transcriptional and the posttranslational level. The combined effect of translational discrimination and endonucleolysis may therefore play an important role in the regulation of IGF-II expression.

Animals↗