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Biomedical subjects

K Nygaard

Publications and source records attributed to K Nygaard.

At least 37 records · Page 2Linked to original sources
PubMed1998

Diagnosis of acute left-sided colonic diverticulitis by three radiological modalities.

PURPOSE: To compare the findings at US, CT and contrast enema (CE) with the clinical, biochemical, and surgical findings in patients with suspected acute left-sided colonic diverticulitis (ALCD). MATERIAL AND METHODS: The study comprised 32 consecutive patients hospitalized with clinically diagnosed ALCD. During the first 3 days of hospitalization, they were examined by US and CT of the pelvis and abdomen, and CE. RESULTS: Of the 32 patients, 21 had ALCD according to the combined radiological, clinical, biochemical and surgical findings. Findings compatible with ALCD were verified by radiological examination alone in 12 patients (4 patients at US, 10 at CT, and 6 at CE). In 9 patients, only diverticula or tethering was found at either CE or CT, and the diagnoses were then supported by clinical and biochemical findings and clinical follow-up. The most common clinical symptoms and signs associated with ALCD were left lower quadrant pain, left-sided tenderness, and fever. Most patients showed elevations of the white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein, but there was no statistical difference in the stages of severity of ALCD, or between ALCD and other abdominal disorders. CONCLUSION: Radiological examination is valuable in confirming the diagnosis of ALCD. CT was the radiological modality that best demonstrated ALCD and revealed complications (e.g. pericolic abscesses) during the course of the illness.

Acute Disease↗
PubMed1997

Randomized controlled trial of postoperative radiotherapy and short-term time-scheduled 5-fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Norwegian Adjuvant Rectal Cancer Project Group.

BACKGROUND: The purpose of the present study was to investigate whether a 1-month regimen of postoperative radiotherapy combined with 5-fluorouracil could reduce the local recurrence rate and improve survival in patients with Dukes B and C rectal cancer. METHODS: One hundred and forty-four patients were randomized to surgery alone or surgery combined with postoperative radiotherapy (46 Gy) and bolus 5-fluorouracil 30 min before six of the radiotherapy fractions. One hundred and thirty-six patients were eligible. RESULTS: The adjuvant treatment was well tolerated. After an observation time of 4-8 years, patients in the adjuvant treatment group had a cumulative local recurrence rate of 12 per cent compared with 30 per cent in the group that had surgery only (P = 0.01). The 5-year recurrence-free and overall survival rate was 64 per cent in the adjuvant group compared with 46 per cent (P = 0.01) and 50 per cent (P = 0.05) respectively in the surgery group. The adjusted relative risk of recurrence and death for the adjuvant group was 0.48 (95 per cent confidence interval 0.28-0.82) and 0.56 (0.33-0.94) respectively. CONCLUSION: The 1-month postoperative combination regimen improved treatment results in patients with Dukes B and C rectal cancer, in terms of local recurrence rate, recurrence-free survival and overall survival, without serious side-effects.

Adult↗
PubMed1996

[Diverticulitis of the colon. Diagnosis and treatment illustrated by a patient material].

During the period 1985-92, 181 patients were treated at Aker Hospital for diverticulitis of the colon. 106 patients (59%) were treated conservatively, and 75 (41%) were operated on for complications. The mortality among the patients treated conservatively was 4.7%. 47 patients underwent operation in the acute stage, most often for perforation or intestinal obstruction, and the most frequent operation was the Hartmann procedure. 28 patients had an elective operation, the most common indication being a fistula from the colon. In this group the operation was usually resection with anastomosis. After acute operation, 17 patients (36%) experienced surgical complications, and the mortality was 12.8% (six patients). After elective operation the morbidity was low (2/28), and the mortality was nil. Our preferred principle for acute surgery for diverticulitis is colonic resection. This eliminates the source of contamination, and allows debridation and cleansing of the peritoneum.

Adult↗
PubMed1994

[Crohn disease. Long-term effects of surgical treatment].

Surgical treatment of Crohn's disease is an alternative when the symptoms are not adequately relieved by drugs. The initial result of intestinal resection is usually good, but in most cases the disease re-occurs after varying periods of time. The article describes a study of the long-term results of surgical treatment. 58 patients were followed up 10-25 years after surgery. 38% had been re-operated within ten years, and 54% within 15 years. None of the patients had been re-operated more than 15 years after the initial operation. After an average observation time of 18 years, 35% had no symptoms, and 65% had symptoms probably caused by Crohn's disease. Of the 17 patients with no clinical symptoms at follow-up, 11 had been re-operated once or several times. Only six of the patients were symptom-free without reoperation. The authors conclude that, although a permanent cure of Crohn's disease is rarely achieved by surgery, it is a valuable form of treatment for patients with incapacitating symptoms.

Adolescent↗
PubMed1994

Topical metronidazole treatment in pouchitis.

Patients with pouchitis usually respond to oral metronidazole treatment, but side effects of the treatment are common. Eleven patients with pouchitis were given local treatment by instillation of metronidazole in doses of 40-160 mg daily into the reservoir. The effects of the treatment on the bacterial flora and short-chain fatty acids in reservoir contents, morphology of the ileal mucosa, and serum concentrations of metronidazole were studied. All patients responded to local administration of metronidazole. Three patients with chronic pouchitis remained well for 6 months, 3 years, and 4 years, taking 40 mg metronidazole daily. Three patients had one single treatment course, and four had repeated courses when they had recurrences. In one patient a continent reservoir had to be removed owing to a persistent ulcer causing chronic blood loss. The bacterial flora of reservoir contents showed no significant differences between patients with and without pouchitis. The number of anaerobic microorganisms and the concentration of short-chain fatty acids were reduced after metronidazole treatment. Serum concentrations of metronidazole were very low, and no patients experienced any side effects of the treatment. In conclusion, topical application of small doses of metronidazole relieved symptoms in most cases of pouchitis and was well tolerated, even as long-term treatment.

Adenomatous Polyposis Coli↗
PubMed1993

[Achalasia. Diagnosis and therapeutic effect evaluated by esophageal manometry].

Achalasia was diagnosed in 57 patients from 1982 through 1991. 13 patients were evaluated by manometry both before and after pneumatic dilatation of the sphincter. There were no serious complications. All but one patient experienced good symptomatic effect; one patient was operated after two ineffective dilatations. The tonus and length of the lower oesophageal sphincter decreased significantly, but dilatation did not improve the swallow-induced relaxation of the sphincter, nor peristalsis in the oesophageal body. In three randomly selected patients, transcutaneous nervous stimulation did not have any symptomatic effects, nor did it affect the motility pattern of the oesophagus. Pneumatic dilatation of the lower oesophageal sphincter is a safe and effective first-choice treatment for achalasia, with myotomy being reserved for patients whose symptoms are not relieved successfully after two dilatations.

Catheterization↗
PubMed1993

[Rectal prolapse. Experiences with rectopexy and Delorme's operation].

During the period 1982-91, 52 patients were treated for rectal prolapse. We present the results for 25 treated with Delorme's operation and 14 with rectopexy, all of whom were observed for more than 12 months after operation. Four patients who had internal prolapse were treated with rectopexy. Eight (15%) of 52 patients had postoperative complications, including six in the Delorme group and two in the rectopexy group. A 75 year-old woman operated with rectopexy died from peritonitis. Eight patients (32%) developed recurrent prolapse after Delorme's operation. Five of these were successfully reoperated. No patients in the rectopexy group had a recurrent prolapse. Incontinence and bleeding were reduced in both groups. Despite a relatively high rate of recurrence, we consider Delorme's operation to be a good alternative, also for old debilitated patients, and to involve a minimal risk of serious complications. If recurrence occurs, reoperation can be carried out with good results.

Adult↗
PubMed1993

Faecal calprotectin: a novel test for the diagnosis of colorectal cancer?

Calprotectin, a prominent cytosol protein in neutrophil granulocytes, was present in increased concentrations in stools from 50 of 53 patients with colorectal cancer, 32 of 40 patients with colorectal polyps, and all of 18 patients with gastric cancer. After radical surgery, faecal calprotectin levels reverted to the normal range in all but one patient with colorectal cancer. Calprotectin determinations are simplified by the stability of this protein in stools. Reliable estimates can be obtained in samples of only 5 g. On the basis of data from the literature, the test for calprotectin seems better than that for occult blood for the detection of gastrointestinal neoplasms.

Aged↗
PubMed1993

Gastric banding for morbid obesity: five years follow-up.

This paper reports on a five year follow-up of 174 morbidly obese patients (132 women) with gastric banding performed between 1981 and 1985. Mean preoperative weight was 122.6 +/- 1.4 kg (s.e.m.) (body mass index (BMI) = 41.8 +/- 0.4 kg/m2) and mean overweight was 73.2 +/- 1.6%. After rapid weight loss during the first six months weight levelled off reaching a nadir at 12-18 months. At 12 months mean weight loss was 36.5 +/- 1.2 kg (BMI = 29.1 +/- 0.4 kg/m2). At 60 months BMI had increased to 32.3 +/- 0.6 kg/m2 (P < 0.05 vs. 12 and 24 months). Mean excess weight at 60 months was 33.5 +/- 2.4% with 47.5% of patients maintaining less than 30% overweight. There were no differences in relative weight loss between men and women and no differences between stomal diameter of 12 or 15 mm 60 months after the operation. Early post-operative complications occurred in 25 patients (14.4%), four of whom required reoperation. Three of these re-operations were for perforations, one of which was fatal. Forty-eight patients (28%) had altogether 60 late complications requiring 26 reoperations (14.9%). There has been a total of four deaths (one clearly unrelated, one unknown) in the series. We conclude that gastric banding is a simple and safe gastric restrictive operation that is effective in about 50% of patients weighing between 90-181 kg (BMI 33-69 kg/m2).

Adult↗
PubMed1993

Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis.

A prospective randomized study was performed to assess the value of routine intraoperative cholangiography (IOC) during cholecystectomy for gallstone disease. Four hundred and fifty-seven consecutive patients were screened for the presence of 11 predefined clinical criteria assumed to indicate choledocholithiasis. Two hundred and eighty patients who had no positive criteria and in whom preoperative endoscopic retrograde cholangiography had not been performed were randomized at the operating table to the IOC or no-IOC group. Follow-up was performed 6 to 8 years after the operation with a questionnaire and by use of clinical, biochemical, and radiologic investigations as indicated. Multivariate analysis was used to identify independent predictors of choledocholithiasis and the combination of criteria having the best predictive ability. The frequency of common bile duct calculi at operation was significantly correlated with age and with all clinical criteria except recent or present pancreatitis. However, only serum bilirubin level, cystic duct diameter, demonstration of common bile duct calculi on preoperative imaging or intraoperative palpation, and age at operation were independent predictors of choledocholithiasis. The overall best subset of clinical indicators contained all criteria with the exception of pancreatitis and alkaline phosphatase level. Negative predictive ability of the set of criteria was 100% for patients up to 60 years of age and 97% for patients older than 60 years at the time of operation. No case of residual common bile duct calculi was present in the IOC and no-IOC groups at follow-up. Our data strongly support a policy of performing IOC during cholecystectomy only when clinical criteria suggest the presence of common bile duct abnormalities or to clarify ductal anatomy.

Biliary Tract↗
PubMed1992

Bleomycin/cis-platin as neoadjuvant chemotherapy before radical radiotherapy in localized, inoperable carcinoma of the esophagus. A prospective randomized multicentre study: the second Scandinavian trial in esophageal cancer.

Survival and swallowing function were studied in a randomized trial of 97 patients with inoperable, localized esophageal carcinoma. Radical radiotherapy was given to 51 patients, while 46 patients had two courses of bleomycin/cisplatin before radiotherapy. The survival was 29% after one year, and 6% after 3 years in the radiotherapy group. The survival in the combined treatment group was 18 and 0%, respectively; p = 0.1895. The number of patients who could swallow any food increased from 6% before treatment to 38% after 3 months in the radiotherapy group, and from 0% to 23% in the combined group. No benefit was found by combining bleomycin/cisplatin with radiotherapy.

Aged↗
PubMed1992

Breath methane and colorectal cancer.

The association between colorectal cancer and breath methane is controversial. We compared a group of 59 patients with unresected colorectal cancer with a group of control subjects matched for age and sex. We also studied 43 of the cancer patients before and 3-6 months after resection. Sixty-three per cent of the patients with unresected carcinoma and 56% of the control subjects were methane excretors (NS). We found no significant change in methane excretion status after resection. Because recent colonic cleansing has been shown to influence methane production in the colon, 15 breath methane excretors were studied immediately before the start of cleansing, on the day of colonoscopy, and on the 7th day thereafter. Forty per cent became breath-methane-negative on the day of colonoscopy, but all 15 were excretors with a median of 60% of the precleansing concentration on the 7th day. The present study does not confirm an association between breath methane and colorectal cancer. It is unlikely that colonic cleansing procedures influenced the results of this study.

Adenocarcinoma↗
PubMed1992

Value of computed tomography in preoperative evaluation of resectability and staging in oesophageal carcinoma.

OBJECTIVE: To evaluate computed tomography (CT) as a method of staging patients with oesophageal carcinoma. DESIGN: Retrospective study. SETTING: Ullevaal Hospital, Oslo, Norway. SUBJECTS: 85 patients who presented with oesophageal carcinoma between February 1982 and December 1989. INTERVENTIONS: Assessment by CT was made in all patients. MAIN OUTCOME MEASURES: Correlation with findings at operation, and histological examination of operative specimens. RESULTS: From the findings at operation in the 46 patients who were operated on (resection, n = 39; exploration only, n = 7) the sensitivity, specificity, and accuracy of CT staging of the growth were 80%, 91%, and 88%, and when histological confirmation of infiltration was taken into consideration the figures were 25%, 84%, and 54%, respectively. The sensitivity, specificity, and accuracy of CT detection of lymph node metastases were 22%, 95%, and 55%. CONCLUSION: Staging of oesophageal cancer with CT before operation is useful in judging resectability, but the smaller tumours should be assessed with caution. CT is unreliable in the diagnosis of the depth of infiltration and the presence of lymph node metastases compared with histological examination.

Adenocarcinoma↗
PubMed1991

[Surgical treatment of gastroesophageal reflux. Evaluated by manometry and 24-hour pH monitoring of the esophagus].

From 1980 to 1989, 46 patients underwent surgery for pathological gastro-oesophageal reflux disease; 28 with Nissen technique, nine with Hill technique and nine with a modified Belsey technique. 11 patients (24%) experienced postoperative complications, 21% after Nissen, 33% after Hill and 22% after Belsey. Two of six patients suffered recurrence of their reflux symptoms after Belsey, three of six after Hill and two of 26 (8%) after Nissen. 85% experienced no reflux symptoms after Nissen fundoplication. 17 patients suffered from flatulence, three were not able to belch and two were not able to vomit. Median lower oesophageal sphincter pressure before Nissen fundoplication was 6.0 mmHg and length was 2.0 cm. After the operation the pressure increased to 10.0 mmHg and the length to 3.0 cm. Four patients underwent ambulatory 24-h oesophageal pH monitoring both preoperatively and postoperatively. The preoperative registration was pathological in all patients, but in three patients the postoperative pH was normal.

Adolescent↗
PubMed1991

Mucosal surface area of a reversed intestinal segment in rats.

Only scarce knowledge exists of morphologic changes after antiperistaltic reversal of the small intestine. Previous animal models using a reversed segment of the small intestine after massive intestinal resection have been mostly concerned with assessing absorption. A rat model was therefore developed for the purpose of studying mucosal surface area in the small intestine after reversal of an intestinal segment. A reversal of 10 cm, representing a length of about 10%, was found suitable for the investigation. Marked dilatation of the reversed segment occurred. A pronounced increase in mucosal surface area caused by mucosal hyperplasia was observed. The mucosal surface area in an anastomosed, but not reversed, segment also increased markedly compared with a group undergoing no operation, although less than in the reversed segment. We conclude that a reversed intestinal segment will increase mucosal surface area in an optimal length used for this purpose. This increase is possibly caused by prolonged exposure to intestinal chyme.

Animals↗
PubMed1991

Perforated appendicitis with generalized peritonitis. Prospective, randomized evaluation of closed postoperative peritoneal lavage.

The therapeutic value of closed postoperative peritoneal lavage in perforated appendicitis with generalized peritonitis was assessed in a prospective, randomized study. In all patients the peritoneal cavity was irrigated peroperatively, and all received systemic ampicillin and tinidazole. The patients were randomly allocated to management with (n = 39) or without (n = 44) closed peritoneal lavage. Postoperative infection developed in ten patients of the lavage group and in four controls. The infection was intra-abdominal in one of the former and two of the latter cases. No intergroup difference was statistically significant. The lavage procedure had to be prematurely discontinued in ten cases. Closed postoperative peritoneal lavage is expensive and seems to involve a risk of complications. No clinical benefit could be attributed to the lavage in this series, in which the risk of overlooking therapeutic advantages was calculated as maximally 2.5%.

Adolescent↗