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Biomedical subjects

O Kronborg

Publications and source records attributed to O Kronborg.

At least 145 records · Page 8Linked to original sources
PubMed1987

Initial mass screening for colorectal cancer with fecal occult blood test. A prospective randomized study at Funen in Denmark.

A Danish study allocated at random 30,970 persons to screening with Hemoccult-II and 30,968 as controls in a population of 140,000 between 45 and 74 years old. Persons with known colorectal cancer, adenoma, and distant spread from all types of cancer were excluded. The test was completed in 20,672 persons from August 1985 to September 1986, and 215 (1%) were found to be positive. Colonoscopy in 203 and double-contrast barium enema in 6 detected 37 persons with cancer and 86 with adenomas. Dukes A cancer was detected in 19 in the screening group, in contrast to 2 among controls. Synchronous adenomas were found in 23 with a positive test and 10 controls. Interval cancer was found in nine persons within 1-11 months after a negative test. Eighteen persons got cancer before invitation and six defectors as well. In all, colorectal cancer was detected in 70 persons in the screening group and in 38 controls; the figures for adenomas alone were 103 and 38, respectively. The study is designed to detect a possible reduction in mortality from colorectal cancer of 25% within 5 years after three screenings with intervals of 2 years. The second screening will begin in September 1987. It remains to be shown whether a reduction may be obtained both in mortality and in incidence of colorectal cancer.

Adenoma↗
PubMed1986

Do synchronous adenomas influence prognosis after radical surgery for colorectal carcinoma? A prospective study.

From 1978 to 1983, radical surgery for colorectal cancer was performed in 319 consecutive patients who were included in a prospective evaluation of perioperative and repeated postoperative colonoscopy with polypectomy. Synchronous adenomas were found and removed in 87 patients. The probability of survival without recurrent cancer and of not dying from local and/or distant spread was significantly higher (p less than 0.02) in patients with synchronous adenomas than in those without. This unexpected finding could only to a minor degree be explained by a greater prevalence of well differentiated cancers and fewer poorly differentiated cancers in patients with synchronous adenomas. Detailed analysis revealed only one other major difference between the two groups, namely a higher risk of adenomas developing during follow-up of patients with synchronous adenomas (p less than 0.001). The present results may be relevant to future prospective clinical studies in which perioperative and regular postoperative colonoscopy is included.

Aged↗
PubMed1986

The missing randomized trial of two surgical treatments for acute obstruction due to carcinoma of the left colon and rectum. An interim report.

Between 1978 and 1985, 55 patients with left-sided colonic obstruction presenting as an emergency were randomised to two treatment groups. In Group T (28 patients) a transverse colostomy was performed as a first stage. After recovery, a second stage of resection with anastomosis was carried out and 17 patients had a 'curative' resection. Of these the colostomy was closed as a third stage in 16. In Group R (27 patients) immediate resection with end colostomy and mucous fistula was carried out as a first stage. A 'curative' resection was possible in 25, of whom 5 died postoperatively. Of the 20 remaining patients, 15 underwent a second stage operation in which reanastomosis was carried out. There was no significant difference in cancer-specific survival between the two treatment groups. Six patients having a curative operation in Group T died with recurrence and 1 further death occurred unrelated to cancer, leaving 10 alive at present, 3 of whom have recurrence. Of the 25 patients treated for cure in Group R, 5 died postoperatively, 9 died with recurrence and 11 were still alive at the time of this assessment, 1 of whom has recurrence. The results at this intermediate stage of assessment indicate no advantage for immediate resection in terms of treatment mortality and long-term survival over an initial transverse colostomy.

Acute Disease↗
PubMed1986

Suprapubic bladder drainage in elective colorectal surgery.

Suprapubic bladder drainage was assessed in 399 patients, following surgery of the rectum and sigmoid colon. An Argyle-Ingram catheter no. 16 French was inserted after the laparotomy incision had been made. The bladder was drained continuously for 24 hours, after which the catheter was closed and reopened every 6 hours for 10 minutes. The catheter was removed when the postvoided volume became less than 50 ml on each of two subsequent measurements. Abdominoperineal excision required the longest drainage period. Urethral catheterization became necessary in 13 men and six women because of persistent or recurrent urinary retention. Failures of suprapubic drainage made urethral catheterization necessary in 17 of 31 patients. Uroperitoneum, due to leakage from the bladder after removal of the suprapubic catheter, was seen in one patient with infravesical obstruction and bladder diverticula. The patient recovered after relaparotomy and suture of the bladder. Suprapubic drainage is recommended because it permits spontaneous voiding. Urethral instrumentation is avoided in most cases. Residual volume can be measured without urethral catheterization. Complications are few, and discomfort to the patient is seen in no more than 1 percent.

Adolescent↗
PubMed1986

Benign colonic neoplasm at the site of ureterosigmoidostomy.

A benign colonic polyp with epithelial dysplasia developed in a young male at the site of ureteral implantation in the sigmoid colon following ureterosigmoidostomy for urinary incontinence. Patients with ureterosigmoidostomy represent a high-risk cancer group, and a review of the literature suggests the necessity of a life-long follow-up in these patients. A follow-up plan with Hemoccult test each year and a sigmoidoscopy every 3rd year is proposed.

Adult↗
PubMed1986

Participation in mass screening for colorectal cancer with fecal occult blood test.

A Danish, randomized study with Hemoccult-II, including 60,000 persons between 45 and 74 years old, began in 1985. Methods of increasing acceptability are described for the first 8000. The first 1000 refusals are also analyzed. Written invitations including prestamped envelopes for return of the slides resulted in an acceptability of 58.8%. Two reminders increased the figure to 65.6%. Personal attempts to change the mind of those refusing increased the last figure to 68.9%. Incomplete slides were returned by 49 persons, but on request 43 sent a complete set. All 78 persons with positive tests had colonoscopy, which detected carcinomas in 10 and adenomas in 39. The study confirmed that results of trials from different countries are difficult to compare because of major differences among populations and methods. However, the present results were similar to those obtained in a Swedish study including only persons between 60 and 64 years old.

Aged↗
PubMed1985

Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up.

Three treatments for chronic pilonidal disease were compared in a randomized trial. Healing without formation of new sinuses occurred equally frequent after excision (E), excision with suture (E + S) and excision with suture under cover with clindamycin (E + S + C). The times of healing were significantly shorter after E + S (median 14 days, n = 29) than after E (64 days, n = 29) and tended to be even shorter after E + S + C (11 days, n = 30). Recurrence rates within 3 years amounted to 13 per cent after E, 25 per cent after E + S and 19 per cent after E + S + C, but the total time of healing after initial surgery as well as excision of recurrences was significantly shorter after E + S than after E and tended to be even shorter after E + S + C.

Adolescent↗
PubMed1985

To lay open or excise a fistula-in-ano: a randomized trial.

Two treatments for fistula-in-ano were compared in a randomized trial. Times of healing were significantly shorter when the fistula was laid open (median 34 days, n = 26) than after excision (41 days, n = 21) (P less than 0.02). Revisional surgery was necessary before healing could be obtained in 3 of 26 patients after lay open operations and 2 of 21 after excision. Recurrence rates within 1 year were similar (3/24 and 2/21).

Adult↗
PubMed1985

Enterocutaneous fistulization due to Actinomyces odontolyticus. Report of a case.

A case of abdominal actinomycosis originating from the sigmoid colon is presented. Actinomyces odontolyticus was isolated; it is a rarity, but should be suspected in the case of a palpable mass and several fistulas developing after a latent period of weeks to months following surgical or inflammatory trauma. The diagnosis is made by anaerobic cultivation. Primary treatment with large doses of penicillin for several weeks may be supplemented by surgery. The strain isolated in the present case was only moderately sensitive to penicillin and was successfully treated with erythromycin.

Actinomycosis↗
PubMed1985

Rectal prolapse and anal incontinence treated with a modified Roscoe Graham operation.

The results of abdominal mobilization of the rectum and repair of the pelvic floor behind the anorectal junction are reported in 23 patients with rectal prolapse, being accompanied by some form of anal incontinence in 12. Within 20 months, on the average, three patients had recurrent prolapse. Two thirds of the patients with incontinence for solid and/or fluid feces were cured for prolapse as well as incontinence. Seven became constipated, while 14 were fully satisfied. Seven of eight patients with a highly reduced tone of the external sphincter before surgery had a marked improvement after surgery. The results do not differ greatly from those after the suspension operation or repair of the pelvic floor in front of the rectum, despite being more physiologic, but suggest that simultaneous suspension and abdominal repair of the pelvic floor may avoid the need for a secondary postanal repair from below in patients with persistent incontinence after suspension surgery. A controlled, randomized trial is advocated.

Adult↗
PubMed1985

Topical ampicillin in addition to a systemic antibiotic prophylaxis in elective colorectal surgery. A prospective randomized study.

Prophylactic use of topical ampicillin in addition to intravenous ampicillin and metronidazole was studied in a randomized trial including 203 consecutive patients undergoing elective colorectal surgery. All received ampicillin, 1 g X 3, and metronidazole, 0.5 g X 3, intravenously for at least three days from induction of anesthesia, and 105 also received topical ampicillin, 1 g, in each of the surgical wounds. Deep wound infection or dehiscence was seen in 12 of 105 having both administrations of antibiotics, and in nine of 98 having only intravenous antibiotics. The two groups were similar according to distribution of sex, age, type of surgery, and efficiency of bowel preparation. Topical ampicillin should be omitted in elective colorectal surgery when systemic prophylaxis with ampicillin and metronidazole is used.

Administration, Topical↗
PubMed1985

Reproducibility and diagnostic value of Hemoccult-II test. A colonoscopic evaluation in asymptomatic patients.

Inter-observer agreement rate in double readings of 246 Hemoccult-II tests was 0.88 (Kappa analysis). The slides were not rehydrated. The Hemoccult-II test was performed immediately before 748 total colonoscopies in asymptomatic patients after previous polypectomy or radical surgery for cancer to estimate the diagnostic value of the test in mass screening, accepting a higher prevalence of neoplasia in the study group but realizing that colonoscopy can only be performed in high-risk groups. Another purpose was to investigate the possibility of replacing colonoscopy with Hemoccult-II in surveillance after previous adenoma or cancer. The 79 colonoscopies after a positive test showed cancer in 3, adenomas in 13, and other intestinal pathology in 34 cases. The 669 colonoscopies after negative tests showed cancer in 1, adenomas in 67, and other pathology in 141 cases. In conclusion, the test cannot be used as a guideline for colonoscopy in follow-up programs for patients who have had adenomas, since it missed 84% of the new cases in the present series. The test does not exclude the presence of colorectal carcinoma, but the risk of cancer is probably several times less in patients with negative tests (1 of 669) than in patients with positive tests (3 of 79), which may justify the use of the Hemoccult-II test for mass screening in asymptomatic populations.

Adenoma↗
PubMed1985

Hyperplasia or neoplasia. Macroscopic versus microscopic appearance of colorectal polyps.

Small light-red sessile colorectal polyps, 1-5 mm in diameter, are generally believed to be hyperplastic (non-neoplastic), whereas polyps that are dark-red in contrast to the surrounding mucosa are thought to be adenomas. This hypothesis was tested prospectively in a series of 209 polyps removed by one endoscopist in a 6-month period. A 'blinded' pathologist provided the histopathological diagnosis. Twenty-two per cent of polyps described as hyperplastic by the endoscopist were adenomas, whereas 40% of those believed to be adenomas, 1-5 mm in diameter, were hyperplastic. The diagnostic effectivity of the endoscopist increased with increasing size of the polyps. In conclusion, all colorectal polyps must be removed to prevent possible precancerous lesions from being left behind and to define a group of patients with increased risk of new adenomas, in whom follow-up examinations should be considered.

Adenoma↗