Biomedical subjects

S Laurberg

Publications and source records attributed to S Laurberg.

At least 19 recordsLinked to original sources

PubMed2007

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 2: long-term outcome.

OBJECTIVE: We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant literature starting from 1992. We selected hospital caseload, surgeon's caseload and surgeon's education, type of hospital, and surgeon's experience as variables of interest. Measures of outcome were recurrence-free survival and overall survival, and for rectal cancer frequency of permanent stoma. We reviewed the 34 studies according to tumour location: colonic cancer, rectal cancer, or colorectal cancer. We described the studies individually and performed a meta-analysis whenever it was considered appropriate. RESULTS: For colonic cancer, overall survival improved with increasing hospital caseload, odds ratio (OR) 1.22 [95% confidence interval (CI) 1.16-1.28], and surgeon's education. For rectal cancer, overall survival improved with increasing hospital caseload, OR 1.38 (95% CI 1.19-1.60), and, possibly by surgeon' education and experience. Cancer-free survival was strongly influenced by surgeon's education. The colostomy rate was less in high caseload hospitals, OR 0.76 (95% CI 0.68-0.85). For colorectal cancer, overall survival improved with surgeon's education. CONCLUSION: The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.

Colonic Neoplasms↗

PubMed2007

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome.

OBJECTIVE: An association between caseload and outcome has been reported for complex surgical procedures. We systematically reviewed recent literature to determine whether caseload and surgical speciality are associated with short-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant publications starting in 1992. We selected hospital caseload and type, and surgeon's caseload, education and experience as variables of interest. Measures of outcome were postoperative morbidity, in-hospital and 30-day mortality, and for rectal cancer anastomotic leak. We stratified the 35 reviewed studies by tumor location: colonic cancer, rectal cancer, or colorectal cancer and described the studies individually. A meta-analysis was performed only when it was considered appropriate. RESULTS: For colonic cancer, postoperative morbidity was associated with surgeon's caseload and education. Postoperative mortality was strongly associated with hospital caseload (OR 0.64, 95% CI 0.55-0.73), and surgeon's caseload (OR 0.50, 95% CI 0.39-0.64). It was also influenced by surgeon's education and experience. For rectal cancer, we found no evidence of an association between the selected variables and short-term outcome, including frequency of anastomotic leak. For colorectal cancer, there was evidence for an association between postoperative morbidity and hospital caseload. CONCLUSION: Our review offers evidence for a positive association between high hospital caseload, surgeon's caseload, sub-speciality and experience and improved short-term outcome in colonic cancer surgery. We failed to find evidence of a relationship for rectal cancer surgery, possibly owing to methodological artifacts. No study reported an inverse relation.

Clinical Competence↗

PubMed2006

Ano-rectal motility responses to pelvic, hypogastric and pudendal nerve stimulation in the Göttingen minipig.

UNLABELLED: We investigated the effect of efferent stimulation of the pelvic (PN), hypogastric (HGN) and pudendal (PuN) nerves on ano-rectal motility in Göttingen minipigs using an impedance planimetry probe. Changes in the rectal cross-sectional area (CSA) at five axial positions and pressures in the rectum and anal canal were investigated simultaneously. Pelvic nerve stimulation elicited a CSA decrease in the proximal part of the rectum and a simultaneous CSA increase in its distal part. Anal pressure also decreased. Hypogastric nerve and PuN stimulation elicited an increase in anal pressure, but no rectal response. Severing the HGN produced a persistent reduction in resting anal pressure, but no change was observed when the PN and the PuN were severed. Stimulation of the distal part of all three nerves produced a persistent response. Administration of phentolamine and pancouronium eliminated the response to stimulation of the HGN and the PuN, respectively. CONCLUSION: Rectal responses to PN stimulation vary more than previously suggested. The HGN has an excitatory effect on the internal anal sphincter, and the PuN on the external anal sphincter. However, the PuN plays no major role in maintaining basal anal pressure.

Anal Canal↗

PubMed2006

Reported symptoms, diagnostic delay and stage of colorectal cancer: a population-based study in Denmark.

OBJECTIVE: The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC). PATIENTS AND METHODS: Population-based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients' reported symptoms were determined through questionnaire-interviews. Dukes' stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: < or = 60, 61-150 and > 150 days. Stage was classified into nonadvanced (Dukes' A and B) or advanced (Dukes' C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals. RESULTS: The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms. CONCLUSIONS: Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC - rectal bleeding - was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer.

Colonic Neoplasms↗

PubMed2006

Postoperative physical training following colorectal surgery: a randomised, placebo-controlled study.

BACKGROUND AND AIMS: Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function. MATERIAL AND METHODS: Randomised, placebo-controlled, single-blinded study. Participants were unselected patients > or = 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36). RESULTS: Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups. CONCLUSION: Postoperative training did not improve physical function, but reduced fatigue in hospital.

Aged↗

PubMed2005

Neurogenic bowel dysfunction score.

STUDY DESIGN: Cross-sectional questionnaire study. OBJECTIVES: To develop and validate a symptom-based score for neurogenic bowel dysfunction (NBD): NBD score. SETTING: University Hospital of Aarhus, Denmark. METHODS: A questionnaire including questions about background parameters (n=8), faecal incontinence (n=10), constipation (n=10), obstructed defecation (n=8), and impact on quality of life (QOL) (n=3) was sent to 589 Danish spinal cord injured (SCI) patients. The reproducibility and validity of each item was tested in 20 and 18 patients, respectively. Associations between items and impact on QOL were determined by logistic regression analysis. The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QOL. Based on odds ratios for associations between items and impact on QOL, each item was given a corresponding number of points in the NBD score. RESULTS: A total of 424 SCI patients responded. The following 10 items met the criteria above: frequency of bowel movements (0-6 points), headache, perspiration or discomfort before or during defecation (0-2 points), tablets and drops against constipation (0-2 points each), time used for each defecation (0-7 points), frequency of digital stimulation or evacuation (0-6 points), frequency of faecal incontinence (0-13 points), medication against faecal incontinence (0-4 points), flatus incontinence (0-2 points) and perianal skin problems (0-3 points). Differences in NBD score among patients reporting no, little, some or major impact on QOL were statistically significant (all P<0.001). CONCLUSION: Based on valid and reproducible questions, we have constructed a score for NBD that is correlated to impact on QOL.

Adolescent↗

PubMed2005

Caffeine improves endurance in 75-yr-old citizens: a randomized, double-blind, placebo-controlled, crossover study.

This study investigated the effect of caffeine on physical performance in healthy citizens aged > or =70 yr. The randomized, double-blind, placebo-controlled, crossover study was conducted in 15 men and 15 women recruited by their general practitioner. Participants abstained from caffeine for 48 h and were randomized to receive one capsule of placebo and then caffeine (6 mg/kg) or caffeine and then placebo with 1 wk in between. One hour after intervention, we measured reaction and movement times, postural stability, walking speed, cycling at 65% of expected maximal heart rate, perceived effort during cycling, maximal isometric arm flexion strength, and endurance. Analysis was by intention to treat, and P < 0.05 was regarded as significant. Caffeine increased cycling endurance by 25% [95% confidence interval (CI): 13-38; P = 0.0001] and isometric arm flexion endurance by 54% (95% CI: 29-83; P = 0.0001). Caffeine also reduced the rating of perceived exertion after 5 min of cycling by 11% (95% CI: 5-17; P = 0.002) and postural stability with eyes open by 25% (95% CI: 2-53; P = 0.03). Caffeine ingestion did not affect muscle strength, walking speed, reaction, and movement times. At the end of the study, 46% of participants correctly identified when they received caffeine and placebo. Caffeine increased exercise endurance in healthy citizens aged > or =70 yr, but the participants' reasons for stopping the test may have varied between subjects, as the cycling test was done at approximately 55% of maximal oxygen consumption. Further studies are required to investigate whether caffeine can be utilized to improve the physical performance of elderly citizens.

Administration, Oral↗

PubMed2005

Gene expression signatures for colorectal cancer microsatellite status and HNPCC.

The majority of microsatellite instable (MSI) colorectal cancers are sporadic, but a subset belongs to the syndrome hereditary non-polyposis colorectal cancer (HNPCC). Microsatellite instability is caused by dysfunction of the mismatch repair (MMR) system that leads to a mutator phenotype, and MSI is correlated to prognosis and response to chemotherapy. Gene expression signatures as predictive markers are being developed for many cancers, and the identification of a signature for MMR deficiency would be of interest both clinically and biologically. To address this issue, we profiled the gene expression of 101 stage II and III colorectal cancers (34 MSI, 67 microsatellite stable (MSS)) using high-density oligonucleotide microarrays. From these data, we constructed a nine-gene signature capable of separating the mismatch repair proficient and deficient tumours. Subsequently, we demonstrated the robustness of the signature by transferring it to a real-time RT-PCR platform. Using this platform, the signature was validated on an independent test set consisting of 47 tumours (10 MSI, 37 MSS), of which 45 were correctly classified. In a second step, we constructed a signature capable of separating MMR-deficient tumours into sporadic MSI and HNPCC cases, and validated this by a mathematical cross-validation approach. The demonstration that this two-step classification approach can identify MSI as well as HNPCC cases merits further gene expression studies to identify prognostic signatures.

Adenocarcinoma↗

PubMed2005

Population-based study of short- and long-term survival from colorectal cancer in Denmark, 1977-1999.

BACKGROUND: Survival rates for patients with colorectal cancer have been lower in Denmark than in other European countries. The aim of this study was to examine temporal trends in relative survival from colorectal cancer between 1977 and 1999. METHODS: All patients diagnosed with colorectal cancer between 1977 and 1999 were identified using the nationwide population-based Danish Cancer Registry. Patients were linked with the Danish Central Population Registry to obtain data on survival to December 2002, and to select ten population controls per patient. RESULTS: A total of 69 562 patients with colorectal cancer were identified, of whom 49.2 per cent were men. Six-month relative survival after diagnosis increased from 69.7 per cent in 1977-1982 to 77.7 per cent in 1995-1999. Five-year relative survival rates increased from 37.8 to 46.8 per cent respectively. Women had slightly higher 5-year relative survival than men throughout the study period. Rectal tumours were associated with better survival than colonic tumours until 2 years after diagnosis, after which tumour location had no impact on survival. CONCLUSION: Relative survival of patients with colorectal cancer has improved in Denmark between 1977 and 1999, most probably reflecting better management of the disease.

Adolescent↗

PubMed2005

Anorectal motility responses to selective stimulation of the ventral sacral nerve roots in an experimental model.

BACKGROUND: Control of defaecation and continence may be lost in patients with spinal cord injury. Electrical stimulation of sacral nerve roots to promote defaecation simultaneously activates both the rectum and the external anal sphincter (EAS), and may actually obstruct defaecation. The aim of this study was to investigate whether the EAS could be blocked selectively by selective stimulation of the ventral sacral nerve roots, and whether activation of the rectum without activation of the EAS could be obtained by stimulation of the ventral sacral nerve roots. METHODS: Selective electrical stimulation was performed using anodal blocking, a tripolar cuff electrode and monophasic rectangular current pulses applied to the sacral nerve roots in nine Göttingen minipigs. RESULTS: Simultaneous responses in the rectum and the anal canal were observed in five animals, whereas only anal responses were noted in four. Variations in cross-sectional area and an increase in rectal pressure seemed to facilitate defaecation. Without blocking, the increase in anal canal pressure was 16-45 cmH(2)O. With blocking, this increase was abolished in seven and reduced to 3-6 cmH(2)O in two animals. CONCLUSION: Selective activation of the rectum is possible using an anodal block of somatic motor fibres. This technique holds promise in further development of electro-defaecation.

Anal Canal↗

PubMed2005

Little effect of physical training on body composition and nutritional intake following colorectal surgery--a randomised placebo-controlled trial.

OBJECTIVE: Postoperatively patients have a reduction in nutritional intake and body weight. We studied the effect of postoperative physical training on nutritional intake and body composition. METHODS: Patients > or =60 y admitted for elective colorectal surgery were randomised to train muscular strength (group A) or to nonstrengthening exercises (group B) for 3 months. Fat mass (FM) and lean body mass (LBM) were assessed with bioimpedance preoperatively, 7, 30, and 90 days postoperatively. Nutritional intake was registered in a subpopulation. RESULTS: Of 119 included patients, 60 were randomised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean (s.d.) of 0.4 (2.1) kg in group A compared to -0.7 (2.0) kg in B. The difference between groups of 1.2 (0.5) kg at day 7 was statistically significant (P=0.03). At no other time was observed difference between groups in weight, LBM, or FM. The energy and protein intake rose during postoperative day 1-7 and rose further after discharge. At no time were differences between groups. CONCLUSION: Physical training had little effect on body composition following abdominal surgery. The nutritional intake in well-nourished patients did not increase by training.

Aged↗

PubMed2005

Differential gene expression in colon cancer of the caecum versus the sigmoid and rectosigmoid.

BACKGROUND AND AIMS: There are epidemiological, morphological, and molecular differences between normal mucosa as well as between adenocarcinomas of the right and left side of the large bowel. The aim of this study was to investigate differences in gene expression. METHODS: Oligonucleotide microarrays (GeneChip) were used to compare gene expression in 45 single samples from normal mucosa and sporadic colorectal carcinomas (Dukes' B and C) of the caecum compared with the sigmoid and rectosigmoid. Findings were validated by real time polymerase chain reaction. RESULTS: Fifty eight genes were found to be differentially expressed between the normal mucosa of the caecum and the sigmoid and rectosigmoid (p<0.01), including pS2, S100P, and a sialyltransferase, all being expressed at higher levels in the caecum. A total of 118 and 186 genes were differentially expressed between normal and right or left sided tumours of the colon, showing more pronounced differences in Dukes' C than B tumours. Thirty genes differentially expressed in tumour tissue were common to adenocarcinomas of both sides, including known tumour markers such as the matrix metalloproteinases. Keratins 8, 19, and 20 as well as carbonic anhydrases (II, IV, VII) showed side specific expression and were downregulated in left sided tumours whereas teratocarcinoma growth factor and cyclooxygenase 2 (COX-2) were upregulated in left sided adenocarcinomas. Immunohistochemical analysis confirmed differences in side specific expression for cytokeratin 20 and COX-2. CONCLUSIONS: Differences in gene expression between normal mucosa as well as between adenocarcinomas of the caecum and sigmoid or rectosigmoid exist and should be taken into account when examining new targeted therapeutic regimens.

Adenocarcinoma↗

PubMed2004

Epidural anaesthesia with bupivacaine does not cause increased oedema in small gut anatomoses in pigs.

BACKGROUND AND OBJECTIVE: Epidural analgesia is widely used for abdominal surgery due to the properties of 'stress-free' anaesthesia and superior pain control. Nevertheless, sympathomimetics are known to antagonize inflammation. The present study was performed to investigate if epidural local anaesthetics caused increased local oedema formation. METHODS: Thirty Dansk Landrace pigs were randomized into three groups: epidural bupivacaine, epidural morphine or intravenous (i.v.) fentanyl. All animals were anaesthetized with isoflurane and i.v. midazolam and received an identical fluid regimen. Six small bowel resections were performed over a 3-h period and during the following 3 h the anastomoses were resected. Primary end-points were water content in small bowel and mesentery samples before and after gut anastomosis, lymph flow and urine production. RESULTS: The water content in the small bowel samples was not changed by surgery or by the different anaesthetic protocols. In the mesenteric tissue, there was a highly significant increase in water content of the postanastomotic samples compared to pre-anastomotic samples (P < 0.001) and a significant time treatment interaction was revealed (P < 0.05) suggesting an increase in oedema formation in the epidural local anaesthetic group. Lymph flow did not change during the experiments and there were no significant differences between the groups (P = 0.80). The mean total urine output was 44% higher in the epidural morphine group compared to the local anaesthetic group (P = 0.17). CONCLUSIONS: Surgery did not increase gut wall water content, but acute oedema formation resulted in the peri-resectional mesenterial tissue, more prominently so in the bupivacaine group.

Analgesics, Opioid↗

PubMed2004

New probe for the measurement of dynamic changes in the rectum.

Conventional mano-volumetric techniques cannot measure changes in circumferential dimensions at several axial positions within a bowel segment. Our aims were to validate a new impedance planimetry probe for simultaneously measuring the cross-sectional area (CSA) at five axial positions in vitro and in vivo in 10 anesthetized pigs. The day-to-day coefficient of variation (CV) for CSA measured by the probe in cylindrical tubes of known diameter was 0.8-9.5%. The mean from actual diameter deviation ranged from 2.3 to 6.7%. In a conical tube the day-to-day CV was 2.3-8% and mean percentage deviation -2.8 to 1.0. Interposed narrowing sections caused a total CV of 7-13%. In vivo studies revealed variations in CSA, associated with expulsion of flatus. It is concluded that impedance planimetry allows simultaneous measurement of CSA at several levels within the rectum. In vitro validity was acceptable and alterations in lumen diameter were identified in vivo.

Animals↗

PubMed2003

Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery.

BACKGROUND: Perineal wounds following abdominoperineal resection (APR), for persistent or locally recurrent anal cancer, are associated with poor healing secondary to irradiation therapy. The results of APR combined with a vertical rectus abdominis musculocutaneous (VRAM) flap transposed transpelvically to cover the perineal defect are presented. METHODS: Between 1994 and 2000, 105 patients were diagnosed and treated for anal cancer. Twenty-two (21 per cent) underwent a salvage operation owing to persistent or locally recurrent disease. In eight patients, before 1996, the perineum was closed primarily with serious wound complications in five. In the final 14 patients, primary perineal reconstruction with a VRAM flap was performed. RESULTS: Median age was 65.5 (range 45-78) years. Median follow-up was 14.5 (range 3-41) months. There were no flap-related complications and primary healing was achieved in all patients. Median hospital stay was 17 (range 14-72) days. There were two major complications related to the laparotomy and abdominal closure. CONCLUSION: Combining the salvage operation with a VRAM flap facilitates primary healing after surgical treatment for persistent or locally recurrent anal cancer. A single-stage primary reconstructive procedure is feasible, with an acceptable complication rate and high level of patient satisfaction.

Aged↗

PubMed2003

Female fecundity before and after operation for familial adenomatous polyposis.

BACKGROUND: Knowledge about the fertility of women suffering from familial adenomatous polyposis (FAP) is scarce and inconclusive. The purpose of this study was to investigate the fecundity of women with FAP before and after operation, and to compare the findings with those of a general population database and women with ulcerative colitis. METHODS: A questionnaire concerning reproductive experiences and waiting times to pregnancy was sent to all 230 women on the polyposis registers in Denmark, Finland, Sweden and Norway in whom primary surgery had consisted of ileorectal anastomosis or ileal pouch-anal anastomosis. Data on the general population and women with ulcerative colitis came from an existing database. Cox regression and Kaplan-Meier plots were used for analysis. RESULTS: The fecundity of women with FAP before operation and after colectomy with ileorectal anastomosis was similar to that of the general population. However, fecundity dropped to 54 per cent (P = 0.015) following proctocolectomy with ileal pouch-anal anastomosis, although it was greater than the postoperative fecundity of women with ulcerative colitis. CONCLUSION: The significant reduction in female fecundity after ileal pouch-anal anastomosis should be communicated to young women with FAP before it is decided which surgical option to follow.

Adenomatous Polyposis Coli↗

PubMed2003

The impact of delivery on anorectal function in women with and women without anal incontinence--a prospective study.

A prospective study was carried out to evaluate the effect of delivery on anal physiological parameters in anally incontinent women (n=18) compared with continent women (n=42). Perineal plane, anal manometry, anal mucosa electrosensitivity and pudendal nerve terminal motor latency (PNTML) were all assessed at 26 weeks' gestation and at 3 and 6 months after delivery. No major effect on the incremental changes in anal physiological parameters was seen from 26 weeks of gestation to 3 months after delivery. At 26 weeks of gestation perineal plane and maximal squeeze pressure were impaired in incontinent women (P=0.02 and P=0.06); PNTML was impaired in incontinent women 6 months after delivery (P=0.05). Irrespective of continence status, delivery had an adverse effect on maximal squeeze pressure and PNTML. No major incremental changes were found between incontinent and continent women after delivery. However, there was a tendency to a higher degree of impairment of maximal squeeze pressure among incontinent women. Delivery per se had an adverse effect on maximal squeeze pressure and PNTML irrespective of continence status.

Adult↗

PubMed2003

Colorectal transport during defecation in patients with lesions of the sacral spinal cord.

Normal defecation involves reflexes between the colorectum and sacral spinal cord. Lesions of the conus medullaris or cauda equina interrupt such reflex arches and cause constipation. The aim of the study was to compare colorectal transport during defecation in patients with sacral spinal cord lesions and healthy volunteers. Ten patients with sacral spinal cord lesions (six men and four women, age 21-57 y, median = 36) and 16 healthy volunteers (10 men and six women, age 22-42 y, median = 30) took one or two doses of 111In-labelled polystyrene pellets perorally to mark colorectal contents. Abdominal scintigraphy was performed before and after defecation. Total colorectal emptying and segmental antegrade or retrograde transport was computed. Median colorectal emptying during normal defecation was 81% of the rectosigmoid (range: 53% of the rectosigmoid to complete emptying of the rectosigmoid and 40% of the descending colon) in healthy volunteers and 27% of the rectosigmoid (range: 0-44% of the rectosigmoid) in patients with conal/cauda equina lesions (P < 0.001). Median antegrade transport was 82% (control group) vs 27% (patients) of the rectosigmoid (P < 0.001), 38% vs 4% of the descending colon (P < 0.02), 13% vs 1% of the transverse colon (P = 0.28), and 4% vs 2% of the caecum/ascending colon (P = 0.76). It is concluded that damage to reflex arches between the colorectum and the sacral spinal cord significantly reduces emptying of the rectosigmoid and descending colon during defecation.

Adult↗