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Biomedical subjects

S Laurberg

Publications and source records attributed to S Laurberg.

At least 37 records · Page 2Linked to original sources
PubMed2003

Colorectal transport in normal defaecation.

OBJECTIVE: Colorectal luminal transport during defaecation can be assessed by means of scintigraphy. However, normal values remain to be established and inter- and intra-subjective variation is unknown. The aim of the study was to describe colorectal transport during normal defaecation by means of a new method for colorectal scintigraphy and to determine inter- and intrasubjective variation. METHODS: Thirty healthy volunteers (18 men and 12 women, age 22-46 years; median 31) took 2 MBq 111In on two consecutive days (days 0 and 1). On days 1 and 2 an abdominal scintigraphy was done before and after defaecation. Changes in colorectal contents were computed in two ways: firstly, assuming ordered evacuation, the extent of colorectal emptying was computed; secondly, antegrade and retrograde transport within the colorectum was computed for each colorectal segment. RESULTS: Median colorectal emptying during normal defaecation was 99% of the rectosigmoid (range: 60% of the rectosigmoid to complete emptying of the rectosigmoid, descending colon, transverse colon and 19% of the caecum/ascending colon). There was no difference between men (median 99% of the rectosigmoid) and women (98% of the rectosigmoid). Day to day variation was large (dispersion=52%) with a trend towards larger defaecation on day 2 than on day 1 (P = 0.09). Large antegrade and retrograde movements of colorectal contents were observed within the colorectum during defaecation. Antegrade transport involved the rectosigmoid (median 99%), the descending colon (median 53%), the transverse colon (median 46%), and the caecum/ascending colon (median 11%). Retrograde transport was mainly from the transverse colon and the descending colon. Colorectal emptying was significantly correlated to the subjective description (P < 0.01) but not to total gastrointestinal or segmental colorectal transit times determined by means of radioopaque markers. CONCLUSIONS: Colorectal scintigraphy before and after defaecation provides detailed information about colorectal emptying and intracolonic antegrade or retrograde transport during defaecation. Inter- and intraindividual variations are large and antegrade and retrograde transport within the colorectum is common.

Adult↗
PubMed2003

Colonoscopy and multidetector-array computed-tomographic colonography: detection rates and feasibility.

BACKGROUND AND STUDY AIMS: Computed-tomographic (CT) colonography has been introduced as a minimally invasive colon examination for the detection of colorectal neoplasms. The aim of this study was to compare the performance characteristics of multidetector-array CT colonography (MDCTC) and conventional colonoscopy in a prospective, blinded design. PATIENTS AND METHODS: Sixty-six symptomatic patients, 75 patients undergoing polyp and cancer surveillance, and seven patients undergoing preoperative colonoscopy due to colorectal cancer (CRC) were examined with MDCTC and subsequent colonoscopy. The gold standard was colonoscopy. If MDCTC was positive and the first-pass colonoscopy was negative, a second-pass colonoscopy served as the gold standard. RESULTS: Complete colonoscopy was achieved in 91% of the patients, while technically satisfying MDCTC was obtained in 76% of the patients (P < 0.01), insufficient air distension in the sigmoid colon being the main problem. MDCTC and colonoscopy both detected all 11 carcinomas. Overall detection rates for polypoid lesions 6 mm or larger in size were 81% (95% CI, 70% to 90%) for MDCTC and 87% (95% CI, 77% to 94%) for colonoscopy (P = 0.52), with a significant difference with regard to the detection of polyps 6-9 mm in size in favor of colonoscopy (P = 0.008). The specificity of MDCTC at a 6-mm level was 97% (95% CI, 92% to 99%). CONCLUSIONS: MDCTC and colonoscopy show equal overall sensitivity for the detection of polypoid lesions 6 mm or larger in size, but more patients are inadequately examined when MDCTC is used.

Adult↗
PubMed2003

Extracolonic findings at computed tomography colonography are a challenge.

AIM: Our aim was to perform a prospective evaluation of the frequency and diagnostic consequences of extracolonic findings at multidetector array computed tomography colonography (MDCTC) in asymptomatic patients undergoing surveillance for former colorectal polyps or cancer. PATIENTS AND METHODS: Seventy five consecutive patients undergoing surveillance for former colorectal cancer (CRC) or large bowel adenoma were examined with MDCTC. Two independent observers evaluated the images with regard to extracolonic findings. Patient records and radiological information systems were reviewed to determine the results and consequences of the workup derived from MDCTC. RESULTS: Sixty five per cent (95% confidence interval (CI) 55-73%) of patients had extracolonic abnormalities and in 12% (CI 7-18%) of patients additional workup was indicated. Two patients (3% (CI 1-6%)) underwent surgery because of the findings (one) or because of complications of the workup (one). CONCLUSION: MDCTC identifies a large number of extracolonic findings. Approximately 12% of asymptomatic patients undergo additional workup, of benefit to only a few. The high prevalence of extracolonic findings may make MDCTC a problematic colorectal screening tool for both ethical and economic reasons.

Adenoma↗
PubMed2002

Rectal wall properties in patients with acute and chronic spinal cord lesions.

PURPOSE: Most patients with spinal cord injuries suffer from constipation or fecal incontinence. This study was designed to observe rectal wall properties and the rectoanal inhibitory reflex in patients with acute and chronic spinal cord injury. METHODS: Rectal wall properties were studied by rectal impedance planimetry, a method for simultaneous registration of pressure and rectal cross-sectional area during distention. Twenty-five patients with spinal cord injury (14 with supraconal lesions and 11 with conal/cauda equina lesions) were studied one to four weeks after injury, and 17 were available for follow-up after 6 to 14 months. Results were compared with 15 healthy volunteers. RESULTS: Rectal tone was significantly higher (P < 0.05) than normal in patients with acute and chronic supraconal lesions but significantly lower (P < 0.05) in patients with acute and chronic conal/cauda equina lesions. The proportion of subjects with single giant rectal contractions was significantly higher than normal (33 percent) after acute supraconal spinal cord injury (77 percent; P = 0.02) but not after acute conal/cauda equina lesions (45 percent; P = 0.69). Phasic giant contractions only occurred in patients with spinal cord injury (once or more in 8 of 25 patients), but they were not correlated with the level of the lesion. Rectal tone and the number of giant rectal contractions did not change significantly from the acute to the chronic phase of spinal cord injury. The amplitude of the rectoanal inhibitory reflex at distention pressures of 5 and 10 cm H2O was significantly lower than normal in patients with acute and chronic conal/cauda equina lesions (acute, -5 and 44 percent vs. 37 and 82 percent (P < 0.05); chronic, 6 percent (P < 0.05) and 66 percent (P = NS)) but not in patients with supraconal spinal cord injury (acute, 32 and 83 percent; chronic, 61 and 85 percent (all P = NS)). CONCLUSION: Rectal tone is stimulated by the sacral spinal cord but inhibited by supraspinal centers within the central nervous system. Likewise, rectal contractility is inhibited by supraspinal centers, and the rectoanal inhibitory reflex is stimulated by the sacral spinal cord. Alterations caused by either type of spinal cord lesion are present after one to four weeks and do not change significantly within the first year.

Acute Disease↗
PubMed2002

Scintigraphic assessment of antegrade colonic irrigation through an appendicostomy or a neoappendicostomy.

BACKGROUND: The aim of this study was to evaluate large bowel transport following antegrade colonic irrigation with a new scintigraphic technique. METHODS: Ten patients (eight with severe constipation, two with faecal incontinence; median age 47 (range 41-66) years) treated with antegrade colonic irrigation took 111In-labelled polystyrene pellets to label the bowel contents. 99mTc-labelled diethylenetriamine penta-acetate was mixed with the irrigation fluid to map its distribution within the large bowel. Scintigraphy was performed before and after a standardized irrigation procedure. The large bowel was divided into four segments. Assuming ordered evacuation of the large bowel, the contribution of each colonic segment to total evacuation was expressed as a percentage of original segmental count. The segmental contributions were added to reach a total defaecation score (range 0-400). RESULTS: The median defaecation score was 350, corresponding to complete emptying of the rectosigmoid, descending colon, transverse colon, and half of the caecum and ascending colon. The retained irrigation fluid was located throughout the large bowel. Back-flow to the ileum was observed in four patients. CONCLUSION: This study used a new scintigraphic technique to assess large bowel transport following antegrade colonic irrigation. Antegrade colonic irrigation induces highly effective emptying even in patients with severe constipation.

Adolescent↗
PubMed2002

Efficacy and tolerability of prucalopride in patients with constipation due to spinal cord injury.

BACKGROUND: Chronic constipation (CC) often occurs after spinal cord injury (SCI). Prucalopride is a novel, highly selective, specific serotonin4 receptor agonist with enterokinetic properties. We evaluate the tolerability and pilot efficacy of prucalopride in the treatment of CC due to SCL. METHODS: Double-blind, placebo-controlled, pilot, phase 11, dose-escalation study. After 4 weeks' run in, patients received prucalopride 1 mg (n = 8) or placebo (n = 4); 11 new patients were randomized to prucalopride 2 mg (n = 8) or placebo (n = 3) once daily for 4 weeks. Patients recorded bowel function (diary) and assessed constipation severity and treatment efficacy (visual analogue scale (VAS) 0-100 mm). Colonic transit times were determined. RESULTS: Compared with run in. mean changes in constipation severity (VAS) increased with placebo, but decreased with prucalopride 1 and 2 mg. The VAS score for treatment efficacy showed a clear dose response (medians 4, 52 and 73 for placebo, 1 and 2 mg, respectively). Diary data showed an improvement in average weekly frequency of all bowel movements over 4 weeks within the 2 mg group (median 0.6; 95% CI 0.2; 1.2). There was a significant reduction in median colonic transit time with 2 mg (n = 4; -38.5 h (95% CI -80; -5)). Four patients (2 mg) reported moderate/severe abdominal pain, and two of these discontinued treatment. There were no clinically relevant effects on any of the safety parameters. CONCLUSION: This pilot study indicates that prucalopride can play an important role in the management of patients with CC due to SCI.

Adolescent↗
PubMed2002

Bowel cleansing methods prior to CT colonography.

PURPOSE: To compare the cleansing effect, ease of preparation and side-effects of two cleansing regimens containing either polyethylene glycol solution (PEG) or phospho-soda (Na-P) solution prior to CT colonography in a prospective, randomized, radiologist-blinded design. MATERIAL AND METHODS: Fifty persons were randomized to receive either a PEG preparation or a Na-P preparation prior to CT colonography. On axial 2D images, the rectum, the sigmoid, the descending, the transverse and the cecum/ascending colon were scored semiquantitatively as to cleanness by two radiologists blinded to the bowel preparation regimen. Quality scores in the two groups were compared. Ease of preparation and side-effects were assessed by a questionnaire. RESULTS: The overall quality of the bowel preparation with the Na-P preparation was better than with the PEG preparation with significantly better cleansing scores for the rectum, the sigmoid, the descending and the transverse colon. The Na-P preparation was significantly better tolerated than the PEG preparation with significantly less nausea and significantly less fecal incontinence. CONCLUSION: The quality of the bowel preparation was better with the Na-P preparation than with the PEG preparation prior to CT colonography. Moreover, the Na-P preparation was better tolerated and with fewer side-effects.

Aged↗
PubMed2002

Frequency of hereditary non-polyposis colorectal cancer in Danish colorectal cancer patients.

BACKGROUND: Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant cancer syndrome, characterised by familial aggregation of HNPCC related cancers, germline mutations in mismatch repair genes, and/or microsatellite instability (MSI) in tumour tissue. AIM: To estimate the frequency of HNPCC among non-selected Danish patients with colorectal cancer (CRC), and to evaluate the value of MSI analysis as a pre-screen test. METHODS: This was a prospective population based study on consecutive CRC patients. A family history of malignancy was obtained and suspected HNPCC cases were screened for hMLH1/hMSH2 mutations and subjected to MSI analysis. Patients with germline mutations and/or those with Amsterdam criteria I or II families were categorised as HNPCC patients. RESULTS: Among 1328 eligible CRC patients, 1200 (90.4%) completed a questionnaire. A total of 1.7% (95% confidence interval (CI) 1.0-2.4) (20 cases) were categorised as HNPCC patients. Amsterdam criteria I or II were met in 18 cases (1.5%), and in another two cases (0.2%) pathogenic hMLH1/hMSH2 mutations were detected without fulfillment of the Amsterdam criteria I or II. Among 77 patients younger than 50 years of age, 11 cases (14.3%) were categorised as HNPCC. The Amsterdam criteria I or II were met in eight of 10 gene carriers (80%). The MSI-high phenotype was demonstrated in all 10 gene carriers. CONCLUSION: The frequency of HNPCC was approximately 1.7% among all CRC cases and 14.3% among patients younger than 50 years of age. MSI analysis is a reliable pre-screen test for hMLH1/hMSH2 mutations in families suspected of having HNPCC.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Role of chance in familial aggregation of colorectal cancer.

A prospective population-based study recorded family trees of 77 colorectal cancer patients younger than 50 years of age. Using mathematical modeling of population age-incidence data, we estimate that 1 (95% confidence limits 0 and 3) of these families is expected to meet the Amsterdam criteria I for HNPCC due to chance clustering of colorectal cancer.

Colorectal Neoplasms, Hereditary Nonpolyposis↗
PubMed2001

Colorectal symptoms in patients with neurological diseases.

Several neurological diseases cause constipation or faecal incontinence restricting social activities and influencing quality of life. As several new treatment modalities have become available within the last few years, doctors treating patients with neurological diseases should be aware of the symptoms and have a basic knowledge of relevant treatment options. Constipation and faecal incontinence are common symptoms in patients with traumatic spinal cord injuries, spina bifida, multiple sclerosis, diabetic polyneuropathy, Parkinson's disease, stroke, and cerebral palsy. New treatment modalities are: prokinetic agents, enemas administered through the enema continence catheter or through an appendicostomy, and biofeed-back. Sacral nerve stimulation is still mostly at an experimental level and colostomy should be restricted to the few patients with most severe problems resistant to other therapy.

Brain Diseases↗
PubMed2001

Patient accuracy of reporting on hereditary non-polyposis colorectal cancer-related malignancy in family members.

BACKGROUND: The cancer family history is important in identifying individuals with hereditary non-polyposis colorectal cancer (HNPCC). The accuracy of a suspected HNPCC family history reported by patients with colorectal cancer was evaluated. METHODS: This was a prospective population-based study including consecutive patients with colorectal cancer. A questionnaire covering the occurrence of malignancy among relatives was completed. RESULTS: A total of 1200 patients with colorectal cancer completed the questionnaire. Fulfilment of Amsterdam criteria I or II according to the patients' reports was rejected in three of 14 cases (false-positive rate 21 per cent). Furthermore, seven of 18 probands whose families met the Amsterdam criteria I or II after verification were identified by further exploration in families who, according to the probands, met weaker criteria (false-negative rate 39 per cent). CONCLUSION: The present study suggests that family studies on HNPCC are not reliable unless the diagnoses of family members are verified from official sources. If endoscopic screening is offered entirely on the basis of unverified information from patients with colorectal cancer, there is a risk that a large proportion of the families will not be offered relevant surveillance.

Adolescent↗
PubMed2001

Randomized clinical trial of laparoscopic versus open appendicectomy.

BACKGROUND: Laparoscopy in patients with a clinical suspicion of acute appendicitis has not gained wide acceptance, and its use remains controversial. METHODS: In a randomized controlled trial of laparoscopic versus open appendicectomy, 583 of 828 consecutive patients consented to participate. Three hundred and one patients were allocated to open appendicectomy and 282 patients to laparoscopy, 65 of whom required conversion to open appendicectomy. Length of stay in hospital was the primary endpoint, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secondary endpoints. RESULTS: Intention-to-treat analysis revealed an equally short hospital stay in the two groups (median 2 days). The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections (P < 0.03) and improved cosmesis (P < 0.001), but the operating time was longer (60 versus 40 min). Laparoscopy was associated with more intraperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater number of gangrenous or perforated appendices in this group, the difference failed to reach statistical significance. CONCLUSION: Hospital stay was equally short, whereas laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Adolescent↗
PubMed2001

Time-dependent intestinal adaptation and GLP-2 alterations after small bowel resection in rats.

Existing data on morphological adaptation after small bowel resection are obtained by potentially biased methods. Using stereological techniques, we examined segments of bowel on days 0, 4, 7, 14, and 28 after 80% jejunoileal resection or sham operation in rats and correlated intestinal growth with plasma levels of glucagon-like peptide-2 (GLP-2). In the jejunum and ileum of the resected rats, the mucosal weight increased by 120 and 115% during the first week, and the weight of muscular layer increased by 134 and 83%, compared with sham-operated controls. The luminal surface area increased by 190% in the jejunum and by 155% in the ileum after 28 days. The GLP-2 level was increased by 130% during the entire study period in the resected rats. Small bowel resection caused a pronounced and persistent transmural growth response in the remaining small bowel, with the most prominent growth occurring in the jejunal part. The significantly elevated GLP-2 level is consistent with an important role of GLP-2 in the adaptive response.

Adaptation, Physiological↗
PubMed2001

Structuring rectal cancer treatment in Scandinavia.

By focusing on surgical technique through special training courses, a significant improvement in outcome after surgery for rectal cancer is evident based on the Scandinavian experience. Overall results have improved because of systematic quality assurance of surgery by way of a national rectal cancer registry. Moreover, in Scandinavia, rectal cancer surgery has been taken out of the general surgeon's armamentarium and is performed only by surgeons who specialize in gastrointestinal (Denmark and Norway) or colorectal (Sweden) surgery.

Humans↗
PubMed2000

[Magnetic resonance imaging of patients with perianal fistulas].

Magnetic resonance imaging (MRI) of the anal canal was retrospectively evaluated during a three year period in 67 patients with suspected perianal fistulae. In six cases the surgeon, who knew the results of the MRI, found a fistula not seen on MRI while MRI showed a fistula in one patient which could not be found at surgery. We recommend MRI in cases where an experienced surgeon has difficulties mapping the fistula tract.

Adolescent↗