[Therapeutic results in rectal cancer surgery. Surgical technique is of great significance].
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Clinical Competence↗
Biomedical subjects
T Holm
Publications and source records attributed to T Holm.
[Congenital dyserythropoietic anemia type III. A case report].
Congenital dyserythropoietic anaemia type III is a rare disorder characterized by mild to moderate anaemia, ineffective erythropoiesis, and morphologic abnormalities of mature red blood cells and their precursors. The most extraordinary feature of this condition is the large number of multinuclear erythroblasts found in the bone marrow, some containing up to 12 nuclei. This type of anaemia is an autosomal dominant inherited disorder, though sporadic cases have been described. Little conclusive is known about the pathogenesis of congenital dyserthropoietic anaemia type III. At present the management of patients consists of observation and supportive care. We describe a 20 year old man who was admitted to a county hospital, showing the typical features of this rare illness. He had a Hb value of 10.2 g/100 ml.
Adult↗
Rectal tumours--MR imaging with endorectal and/or phased-array coils, and histopathological staging on giant sections. A comparative study.
OBJECTIVE: To investigate the accuracy of MR imaging in the preoperative staging of patients with clinically resectable rectal tumours. MATERIAL AND METHODS: Forty-eight consecutive patients with rectal tumours were examined, 29 with a pelvic phased-array coil and 19 with a multi-coil arrangement including a pelvic phased-array coil and an endorectal coil. MR images and histopathological specimens and sections were reviewed independently and tumours were staged according to the TNM classification. RESULTS: A more complete visualisation of the various layers of the rectal wall was achieved on the endorectal MR images than on the pelvic phased-array images. The sensitivity of MR in correctly staging T3 tumours compared with histopathology was 81% with a specificity of 82%. Penetration of the rectal wall was predicted with a sensitivity of 82% and a specificity of 87%. Sensitivity and specificity in predicting lymph node metastases was 83% and 74% respectively. CONCLUSION: MR imaging with both pelvic phased-array and endorectal coils allowed the preoperative staging of rectal tumours with a high degree of accuracy.
Adult↗
Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy.
BACKGROUND: Preoperative radiotherapy reduces recurrence rates after surgery for rectal cancer but other variables may also affect outcome. The Stockholm Rectal Cancer Study Group has conducted two prospective randomized trials on preoperative radiotherapy in rectal cancer. METHODS: This study analysed postoperative morbidity and mortality, local recurrence rate and death from rectal cancer in 1399 patients, according to different hospital- and surgeon-related factors. RESULTS: Patients operated on by surgeons who were certified specialists for at least 10 years had a lower risk of local recurrence (relative risk 0.8 (95 per cent confidence interval (c.i.) 0.6-1.0)) and death from rectal cancer (relative risk 0.8 (95 per cent c.i. 0.7-0.9)). The risk was also lower for patients operated on in university hospitals (relative risk of local recurrence 0.7 (95 per cent c.i. 0.5-0.9), relative risk of death from rectal cancer 0.8 (95 per cent c.i. 0.7-1.0)) compared with community hospitals, although the results in some community hospitals were similar to those in university hospitals. The proportional reduction of local recurrence rate after preoperative radiotherapy was not significantly different for the studied institutions and surgeons. CONCLUSION: There was a significant surgeon-related variation in patient outcome, which is probably related to the surgical technique. Although improved technique may reduce the local recurrence rate, preoperative radiotherapy is still beneficial concerning local control and survival.
Adenocarcinoma↗
Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials.
BACKGROUND: Adjuvant preoperative radiotherapy of patients with primary rectal carcinoma improves local control and survival, but also may increase the risk of early postoperative morbidity and mortality. In addition, the possible late adverse effects of this treatment are largely unknown. METHODS: The present study was based on 1027 curatively operated patients included in 2 prospective randomized trials of preoperative radiotherapy for rectal carcinoma patients (Stockholm I and Stockholm II Trials). The goal was to assess whether long term intercurrent morbidity and mortality were increased in patients allocated to the preoperative treatment. A computerized linkage of the randomized patients to a population-based registry of the Stockholm County Council was used to study hospital admissions for six groups of a priori defined diseases, putatively related to late adverse effects of the radiation. RESULTS: Preoperative radiotherapy significantly increased the incidence of venous thromboembolism (P = 0.01), femoral neck and pelvic fractures (P = 0.03), intestinal obstruction (P = 0.02), and postoperative fistulas (P = 0.01). For arterial disease and genitourinary tract diseases, no difference in risk was found between irradiated and non irradiated patients. Radiotherapy significantly reduced rectal carcinoma deaths in both trials and also improved overall survival in the Stockholm II trial. The late intercurrent mortality was similar in irradiated and nonirradiated patients. CONCLUSIONS: Although high dose, short term, preoperative radiotherapy can improve outcome after surgery for rectal carcinoma, there also may be an increased risk for long term morbidity. Refinement of the radiotherapy technique and a more accurate selection of patients suitable for the treatment will probably further improve the results, at least in regard to treatment-related complications.
Confidence Intervals↗
Postoperative mortality in rectal cancer treated with or without preoperative radiotherapy: causes and risk factors.
Adjuvant preoperative radiotherapy in patients with rectal cancer improves local control and possibly overall survival. However, an increased postoperative mortality rate after radiotherapy has been observed in some trials. This study was based on 1399 patients in two randomized trials of radiotherapy. It reviewed the causes of death after operation and attempted to identify risk factors for postoperative mortality in patients with rectal cancer treated with or without high-dose (5 x 5 Gy) preoperative radiotherapy. The majority of deaths were from cardiovascular disease or infection. The risk of postoperative mortality was significantly increased in patients irradiated with a two-portal technique to a relatively large volume compared with those not given radiotherapy, but not in those irradiated with a four-portal technique to a limited volume. Age, sex, tumour stage and coexistent cardiovascular disease were independent risk factors for postoperative mortality. The risk of postoperative death in patients with rectal cancer is related to the preoperative radiotherapy technique.
Adenocarcinoma↗
MR imaging, CT and CEA scintigraphy in the diagnosis of local recurrence of rectal carcinoma.
PURPOSE: To compare advanced imaging techniques in the diagnosis of recurrent rectal cancer. MATERIAL AND METHODS: Twenty-five consecutive patients with either suspected or verified recurrence were examined by CT (n = 25), MR with phased-array capabilities (n = 24) and CEA scintigraphy (n = 16). Three experienced radiologists (who were blinded to results obtained at surgery and histopathology) independently evaluated the films, one observer for each modality. RESULTS: The MR radiologist arrived at a correct diagnosis in 87.5% of the examinations, the CT radiologist in 76% and the CEA radiologist in 75%. The MR radiologist's results correlated more often with reported pathology than did those of the CT radiologist with regard to the relation of recurrent tumor to surrounding structures in the pelvis. CONCLUSION: MR imaging is the most effective of the 3 modalities in the diagnosis of recurrent rectal cancer.
Aged↗
Abdominoperineal resection and anterior resection in the treatment of rectal cancer: results in relation to adjuvant preoperative radiotherapy.
The outcome of patients with rectal cancer treated by abdominoperineal or anterior resection, with or without preoperative radiotherapy, was assessed to detect any differences attributable to the operative method and interactions between radiotherapy and type of surgery. The study was based on 1292 patients included in two consecutive controlled randomized trials of preoperative radiotherapy in operable rectal carcinoma. The outcome was not related to surgical method. Radiotherapy increased postoperative mortality and complications and reduced local and distant recurrence, but had no effect on overall survival. Effects of radiotherapy were similar irrespective of the type of surgery, except that the increase in postoperative mortality in irradiated patients was greater in those treated with abdominoperineal resection. Sphincter-saving procedures appear to have no adverse effects on outcome of rectal cancer, but the optimum use of radiotherapy is still to be defined.
Adult↗
High incidence of cystic fibrosis on the Faroe Islands: a molecular and genealogical study.
We have studied the genetics of cystic fibrosis (CF) in The Faroe Islands. Based on the number of affected children born during the period 1954-1993, the incidence of CF at birth is 1:1775, which is more than twice the incidence in the rest of Denmark. We have tested all known CF patients and/or their parents for the presence of delta F508 and found it to be the only CF mutation in this population. Based on testing 881 unrelated control individuals, the carrier frequency was estimated to be 1:24, given a calculated incidence of 1:2300. Genealogical studies enabled us to trace several of the families over seven generations. Haplotype investigations within the families suggest that delta F508 was introduced by two founders, probably from the Celtic population in Brittany, Ireland, Wales or the North West of Scotland.
Cystic Fibrosis↗
[Local recurrence after rectal cancer surgery. A surgical and oncological challenge].
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Female↗
Local recurrence of rectal adenocarcinoma after 'curative' surgery with and without preoperative radiotherapy.
The natural history of locally recurrent rectal cancer was analysed to assess whether preoperative irradiation altered the clinical course of the disease. In a randomized controlled trial of 849 patients, the value of preoperative radiotherapy in those with operable rectal adenocarcinoma was examined. After a minimum follow-up of 4 years, 156 patients who developed local recurrence were studied retrospectively. There were no differences concerning symptoms and the site of local recurrence between irradiated and non-irradiated patients. Curative treatment was rarely possible and median survival was only about 1 year, irrespective of adjuvant treatment. Local recurrence was the only manifestation of disease in 30-50 per cent of patients. An earlier and more aggressive surgical approach might improve survival.
Adenocarcinoma↗
The national survey of Indian Vietnam veterans.
Largely through the efforts of Harold Barse and Frank Montour, Readjustment Counseling Service, a division of the U.S. Department of Veterans Affairs, formed a working group to deal with the simple lack of information on Indian Vietnam veterans. Barse is founder of the Vietnam Era Veterans Inter-Tribal Association and a counselor for the Oklahoma City, Oklahoma, Vet Center. Montour is a Vet Center counselor in Lincoln Park, Michigan.
Adult↗
[Nutrition via gastrostomy. Low frequency of complications with PEG].
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Enteral Nutrition↗
Zebrafish pou[c]: a divergent POU family gene ubiquitously expressed during embryogenesis.
We report the isolation and characterization of cDNA for a novel zebrafish (Brachyodanio rerio) POU domain gene, pou[c], which is ubiquitously expressed during embryonic development. This gene encodes a 610 amino acids long protein with a 149 amino acid POU domain ending only 8 residues before the C terminus. The 453 amino acids long region N-terminal to the POU domain contains several features typical of transcriptional activation domains such as an acidic region with a putative amphipathic alpha-helix, a glutamine-rich region, and short threonine- and/or serine-rich regions. Comparison of the POU domain of pou[c] to other known POU sequences clearly show that pou[c] has the most divergent POU domain sequence reported to date. Thus, we suggest that pou[c] should be placed as the presently sole member of a new, sixth class of POU proteins. DNA-binding studies revealed that pou[c] is not an octamer-binding transcription factor like the Oct proteins described from mammals, chicken and Xenopus. Rather, pou[c] binds with high affinity to the TAATGARAT motif found in the promoters of the herpes simplex virus immediate early genes and to degenerate octamer-TAATGA motifs. Circular permutation analyses also show that pou[c] induces DNA bending upon sequence-specific binding.
Amino Acid Sequence↗
General surgery in patients aged 80 years and older.
This study reviews 594 surgical admissions, of patients aged 80 years and older, to departments of general surgery during 1 year. Half of the patients were admitted as emergencies and 60 per cent underwent surgery. The operative mortality rate was 8 per cent and the overall mortality rate for all admissions 9 per cent. The number of complications and the mortality rate after surgery increased in emergency cases and in patients with coexisting disease. Of all admissions, 72 per cent were uncomplicated and in 70 per cent patients could be discharged directly home; such patients do not generally take up beds and are discharged as soon as medical care is no longer indicated. The number of admissions of patients over 80 years of age will increase by about 30 per cent during this decade and, unless additional resources are provided to meet this challenge, new standards must be considered for the distribution of resources and of indications for surgery in both young and old.
Aged↗
[Physicians visiting pharmacies--a deep sigh].
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Denmark↗
NMDA receptor agonists derived from ibotenic acid. Preparation, neuroexcitation and neurotoxicity.
The two heterocyclic aspartic acid and glutamic acid analogues derived from ibotenic acid, (RS)-2-amino-2-(3-hydroxy-5-methylisoxazol-4-yl)acetic acid (AMAA) and (RS)-2-amino-3-(3-hydroxy-5-methylisoxazol-4-yl)propionic acid (AMPA) have previously been shown to be selective agonists at N-methyl-D-aspartic acid (NMDA) and AMPA receptors, respectively. Two analogous series of AMAA and AMPA derivatives have now been synthesized and characterized in receptor binding studies and neuropharmacological experiments. AMAA was shown to be a very potent NMDA agonist in cortical tissue preparations, slightly more active than NMDA, whereas N-methyl-AMAA was less potent and N,N-dimethyl-AMAA almost inactive. (RS)-3-Hydroxy-4,5,6,7-tetrahydroisoxazolo[4,5-c]pyridine-4-carboxylic acid (4-HPCA), a bicyclic analogue of AMAA, exhibited weak NMDA agonist effects similar to those of quinolinic acid. The relative potency as AMPA receptor agonists of AMPA, N-methyl-AMPA, N,N-dimethyl-AMPA and (RS)-3-hydroxy-4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridine-5-carboxylic acid (5-HPCA), a bicyclic analogue of AMPA, was distinctly different from that of the AMAA series of compounds as NMDA agonists. The pharmacological and toxicological profiles of AMAA and 4-HPCA, compared with those of quinolinic acid, are consistent with heterogeneity of NMDA receptors.
Animals↗