Biomedical subjects
O H Hansen
Publications and source records attributed to O H Hansen.
[Picture of the month. Colonic adenoma].
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[Gallstone management in Denmark II].
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[Treatment of gallstones in Denmark].
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[Nothing new under the sun?].
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Laparoscopic cholecystectomy and ERCP--lessons from the Danish National Registry.
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Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series.
BACKGROUND: The risk of bile duct injury in laparoscopic cholecystectomy has been a concern since the procedure became part of the surgical armamentarium. Our study assesses the incidence, types, and treatment for laparoscopic bile duct injury. STUDY DESIGN: Prospective case registration in a national database with participation by all departments of surgery performing laparoscopic cholecystectomy in Denmark since the first operation in January 1991. The case notes for bile duct injury have been reviewed. RESULTS: From 1991 through 1994, 57 of 7,654 patients sustained bile duct injury (0.74 percent; 95 percent confidence interval, 0.55 percent to 0.94 percent), including nine injuries occurring after conversion. The annual incidence did not decrease. Thirty-nine percent of the laparoscopic bile duct injuries were incisions, 39 percent were transections, and 12 percent were clip injuries or strictures. One patient, who sustained transection during open reoperation for bleeding after a converted procedure, died. Bile leaks for reasons other than bile duct injury occurred in 2.1 percent; 71 percent of these were cystic duct leaks. Acute cholecystitis was the indication for laparoscopic cholecystectomy in 968 patients, with 1.3 percent sustaining laparoscopic bile duct injury (95 percent confidence interval, 0.62 percent to 2.08 percent), while the incidence in patients with other indications for laparoscopic cholecystectomy was 0.62 percent (95 percent confidence interval, 0.44 percent to 0.82 percent) (p > 0.05). Preoperative knowledge of bile duct anatomy was available by means of preoperative endoscopic retrograde cholangiopancreatography or intravenous cholangiography in 26 percent of patients undergoing laparoscopic cholecystectomy but this did not reduce the risk of bile duct injury. The frequency of bile duct injury in patients who had intraoperative cholangiography was not significantly different from those who did not. Intraoperative cholangiography was done in 14 cases of injury (diagnostic for injury in 8, misinterpreted in 2, and normal in 4 patients). The case notes described operative difficulties in 11 of 48 cases of laparoscopic bile duct injury, most often because of fibrosis or difficulty delineating the anatomy. CONCLUSIONS: The incidence of bile duct injury in laparoscopic cholecystectomy is higher than previously generally anticipated and did not decrease from 1991 through 1994. Risk factors and possible preventive measures should be evaluated in prospective studies.
[Laparoscopic cholecystectomy in Denmark. A prospective registration].
Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.
Videothoracoscopic lung biopsy by a stapling technique.
OBJECTIVES: To describe initial experience with a new technique for obtaining lung biopsy specimens using video-thoracoscopy and Multifire Endo GIA (U.S. Surgical Corporation) stapler. DESIGN: Retrospective study. SETTING: Central hospital, Denmark. SUBJECTS: Nine patients with suspected pulmonary fibrosis. MAIN OUTCOME MEASURES: Diagnosis, morbidity, and mortality. RESULTS: The endoscopic method provided a specimen of lung tissue large enough to secure a reliable diagnosis in all cases. CONCLUSION: The thoracoscopic technique implies less surgical trauma than thoracotomy resulting in less postoperative pain and a better cosmetic result. In patients suitable for general anaesthesia the endoscopic method for obtaining lung tissue specimen seems to be the ideal method.
Effectiveness of single dose prophylaxis with cefotaxime and metronidazole compared with three doses of cefotaxime alone in elective colorectal surgery.
OBJECTIVE: To compare three doses of cefotaxime alone with a single dose of cefotaxime and metronidazole for the prophylaxis of infection after elective colorectal operations. DESIGN: Prospective random control trial. SETTING: Hillerød and Frederiksberg Hospitals, Copenhagen, Denmark. SUBJECTS: 660 consecutive patients who were to undergo elective colorectal operations during a 48 month period (January 1987-January 1991); 93 (14%) were withdrawn after randomisation leaving 567 for assessment. INTERVENTIONS: Mechanical bowel preparation, and then either cefotaxime (Claforan) 2 g intravenously at induction of anaestesia and 3 and 9 hours later (n = 280) or a single dose of cefotaxime 2 g plus metronidazole (Flagyl) 1.5 g intravenously at induction of anaestesia (n = 287). RESULTS: 44 patients in the cefotaxime group developed wound infection (16%) compared with 19 (7%) in the combined group (p < 0.001). In the cefotaxime group 22 of the 241 patients who had an anastomosis developed leaks (9%) compared with 8 of the 239 in the cefotaxime/metronidazole group (3%). There were no differences in the incidence of intra-abdominal abscesses or burst abdomens. The most common organisms isolated from wounds were Escherichia coli and Bacteriodes fragilis. CONCLUSION: One dose of cefotaxime and metronidazole is active against a wide range of organisms and resulted in significantly fewer wound infections than three doses of cefotaxime alone.
[Laparoscopic cholecystectomy--minimally invasive surgery].
In 1987, Mouret devised a technique of performing cholecystectomy through a laparoscope. When performed correctly and on the right indications, this type of minimal invasive surgery has distinct advantages for the patients. Postoperative hospitalization is reduced to a few days and most of the patients can return to work or normal activities within a week or two. In this department, laparoscopic cholecystectomy was used for treatment of symptomatic gallbladder stones in 34 patients. In three patients the procedure was converted to an open laparotomy. No mortality and no ductal injuries were observed and no re-operations were necessary. The operating time averaged 102 minutes and the postoperative stay was 2.3 days. The average duration of sick-leave was 12 days. We are convinced, that this new technique will play a dominant role in the future treatment of symptomatic cholelithiasis.
[Complications of laparoscopic cholecystectomy].
Among 68 patients who underwent laparoscopic cholecystectomy for treatment of symptomatic gallstones, serious complications occurred in three cases. One patient developed a stricture of the hepatic duct which probably was caused by electrocautery. In one case uncontrollable bleeding from the hepatic artery resulted in enforced conversion to open operation and one patient had a subphrenic accumulation of bile which could be drained percutaneously. In order to reduce the risk of iatrogenic injury to the bile ducts operative choleangiography should be attempted routinely.
[Accident insurance--the physician's role].
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Association between tumor DNA aneuploidy and in vitro tetraploidy of skin fibroblasts in patients with colorectal neoplasms.
In vitro tetraploidy (IVT) in cultures of skin fibroblasts was compared with tumor DNA ploidy, as determined by flow cytometry on paraffin-embedded material, in 99 patients with colorectal neoplasm. In 63 patients with non-heritable carcinoma we found a significant correlation between the number of aneuploid stemlines in the tumor and IVT in the fibroblast culture. Furthermore, tumor aneuploidy was significantly correlated to the size of the tetraploid subpopulation in the fibroblasts. There was no correlation between aneuploidy and Dukes's stage or the degree of differentiation. In 36 patients with adenoma no correlation between tumor aneuploidy and fibroblast IVT was demonstrated, whereas the number of tumor stemlines was significantly correlated to histopathologic stage and grade of dysplasia. IVT in cultured skin fibroblasts, which has been reported to reflect a genetic predisposition to colorectal cancer in heritable colon cancer syndromes, thus seems to be relevant also for the understanding of tumor formation and progression in the 'non-heritable' type of colorectal cancer.
No effect of topical ampicillin prophylaxis in elective operations of the colon or rectum.
Whether or not topical application of ampicillin is necessary in patients undergoing elective colorectal operations was investigated. After mechanical preparation, 193 patients received 2 grams of cefotaxime administered intravenously from the start of the operation; patients received two more doses within the next 12 hours. In addition, patients were randomized to receive or not receive prophylaxis against infection of 2 grams of ampicillin in the site of the incision at closure. Twenty-three patients did not complete the study. Wound infection occurred in five of 81 patients who had topical application of ampicillin compared with six of 89 patients who did not receive prophylaxis; the difference was not significant. There were no significant differences in rates of wound dehiscence, intra-abdominal abscess or anastomotic leakage. Escherichia coli and Bacteroides fragilis were the predominant microorganisms isolated. Thus, topical application of ampicillin did not lower the wound infection rate when there was a preoperative antibiotic administered intravenously.
[Preventive local ampicillin and intravenous cephotaxime in colorectal surgery].
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Sarcomas of the breast: a clinico-pathological study of 67 patients with long term follow-up.
A national Danish series of 68 breast sarcomas from 66 women and one man (age 17-86 years) was investigated. Tumour sections from 22 stromal sarcomas (SS), 24 phyllodes tumors of malignant type (MCSP), seven phyllodes tumors of borderline type (BLCSP), four malignant fibrous histocytomas (MFH), eight liposarcomas, two angiosarcomas and one leiomyosarcoma were reviewed retrospectively, and all patients were traced with a minimum follow-up of 15 years. Tumor contours appeared to be the best prognostic factor in predicting the risk of metastatic spread. Stromal overgrowth of MCSP was considered less utilizable due to difficulties in distinguishing between MCSP with marked stromal overgrowth and SS, which we consider as a variety of MCSP and which only showed slightly increased death rates compared to MCSP (45% versus 38%). Both angiosarcomas and the leiomyosarcoma proved lethal, and the other sarcoma subtypes had a death frequency of about 50%, with the exception of BLCSP, neither of which proved lethal. All patients, who died from metastases, were dead within 5 years irrespective of treatment. No positive lymph nodes were identified at the time of primary treatment, supporting the findings of previous investigators. We therefore advocate simple mastectomy or local excision with a wide margin as sufficient treatment of breast sarcomas. The indications for adjuvant therapy is as yet unclarified.
Nuclear DNA content in prostatic carcinoma measured by flow cytometry: a retrospective study on paraffin-embedded tissue.
The nuclear DNA content in 67 prostatic carcinomas was measured by flow cytometry of nuclear suspensions prepared from paraffin-embedded tissue blocks. A method was developed that provided nuclear suspensions of good quality whether tissue blocks from transurethral resections or transvesical prostatectomies were used. Thirty (43.7%) of the tumors were found to be aneuploid. No significant correlation between clinical stage or histological grade and aneuploidy was demonstrated.