| 1. |
- Jörgren, Fredrik, et al.
(författare)
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Risk factors of rectal cancer local recurrence : population-based survey and validation of the Swedish rectal cancer registry
- 2010
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Ingår i: Colorectal Disease. - : Wiley-Blackwell. - 1462-8910 .- 1463-1318. ; 12:10, s. 977-986
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Despite advances in rectal cancer treatment, local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method: Local recurrence and survival rates of 4153 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results: The 5-year overall and cancer-specific survival rates were 45% and 62% respectively. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48-4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43-1.00)]. Preoperative RT prolonged time to LR but did not significantly influence the survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR. Conclusion: Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow-up for the detection of isolated LR is important. Extended follow up should be considered for patients treated with RT.
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| 2. |
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| 3. |
- Gustavsson, Anders, et al.
(författare)
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Clinical trial : colectomy after rescue therapy in ulcerative colitis-3-year follow-up of the Swedish-Danish controlled infliximab study
- 2010
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 32:8, s. 984-989
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Tidskriftsartikel (refereegranskat)abstract
- Background The long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described. Aim To examine the long-term efficacy of infliximab as a rescue therapy through a 3-year follow-up of a previous placebo-controlled trial of infliximab in acute steroid-refractory ulcerative colitis. Method In the original study, 45 patients were randomized to a single infusion of infliximab 5 mg/kg or placebo, and at 3 months, 7/24 patients given infliximab were operated vs. 14/21 patients given placebo. Three years or later, patients were asked to participate in a clinical follow-up. Results Another seven patients underwent colectomy during follow-up: five in the infliximab group and two in the placebo group. After 3 years, a total of 12/24 (50%) patients given infliximab and 16/21 (76%) given placebo (P = 0.012) had a colectomy. None of eight patients in endoscopic remission at 3 months later had a colectomy compared with 7/14 (50%) patients who were not in remission (P = 0.02). There was no mortality. Conclusion The benefit of rescue therapy with infliximab in steroid-refractory acute ulcerative colitis remained after 3 years. The main advantage of infliximab treatment occurred during the first 3 months, whereas subsequent colectomy rates were similar in the two groups. Mucosal healing at 3 months influenced later risk of colectomy.
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| 4. |
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| 5. |
- Bosaeus, Ingvar, 1950, et al.
(författare)
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Vårdprogram vid tarmsvikt
- 2010
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Ingår i: Svensk Förening för Gastroenterologi.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Gunnarsdottir, Anna
(författare)
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Hirschsprung´s Disease & Gastroesophageal Reflux. Aspects on Two Gastrointestinal Motility Disorders in Childhood
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gastrointestinal motility disorders are common in childhood and in this thesis we look at two of them, i.e. Hirschsprung´s Disease (HD) and gastroesophageal reflux disease (GERD) in five different studies. HD is a congenital disease characterized by an abscence of ganglion cells in myenteric and submucous ganglia, most commonly in the distal part of the large bowel. In Paper I, we have studied the CART peptide (cocaine-and amphetamine regulated transcript), in human bowel prepararions and were able to show for the first time that the CART peptide is localized in normal human bowel. It is primarily expressed in the myenteric ganglia with high colocalization with the neurotransmitters VIP (vasoactive intestinal peptide) and NO (nitric oxide) indicating a functional role in the intestinal wall. CART-IR (immunoreactive) neurons were not found in the aganglionic part of the bowel indicating an intrinsic origin of the peptide. In Paper II the quality of life (QoL) of adults operated on for HD in their childhood was studied. For that, two validated questionnaires were used, SF-36 health survey and GIQLI (gastrointestinal quality of life index). We found that the adults operated on for HD in childhood, had generally normal QoL. The women, however, had worse general and mental health when compared to the normal population. It was also noted that the longer the aganglionic segment was, the more affected the QoL of the patient. In Paper III we compared the outcome, after two year follow-up, of the Duhamel pull-through operation for rectosigmoid HD and the TERPT (transanal endorectal pull-through) method which we introduced in 2005 in Lund. The study showed that patients operated on with the TERPT-method recovered significantly faster and required fewer interventions during follow-up time, without compromising the functional results. Also the cosmetic results were far better for TERPT group. Our result support the use of the TERPT method in favor of the Duhamel pull-through for rectosigmoid HD. PH-monitoring is valuable in the diagnosis of GERD and the gold standard has been catheter-based monitoring. In Paper IV-V we have shown that a wireless esophageal pH-monitoring system is feasible for use and well-tolerated by children, and is to be recommended. Our result found no clear advantage of esophageal pH-monitoring for 48 hours compared to 24 hours in the diagnosis of GERD in children. It was also shown that it is the combination of symptoms, endoscopic findings, pH-monitoring results and pathological examination that gives the most reliable diagnosis of GERD in children.
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| 7. |
- Hörer, Tal M., 1971-, et al.
(författare)
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Complications but not obesity or diabetes mellitus have impact on the intraperitoneal lactate/pyruvate ratio measured by microdialysis
- 2010
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 45:1, s. 115-121
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Studies have shown a higher risk of postoperative complications in diabetic and obese patients. An increased intraperitoneal lactate/pyruvate ratio as measured by microdialysis has been reported before postoperative complications have been discovered. It is not known whether diabetes or obesity have any influence on the intraperitoneal metabolism (lactate/pyruvate ratio, glucose, glycerol) in relation to major abdominal surgery. The aim of this study was to investigate the postoperative intraperitoneal and subcutaneous carbohydrate and fat metabolism as measured by microdialysis in obese and diabetic patients after major abdominal surgery without postoperative complications.Material and methods: Seven obese patients (body mass index > 30 kg/m(2)) and six diabetic but non-obese patients were studied up to 48 h after major abdominal surgery and were compared with 31 non-diabetic, non-obese patients, all without complications. Microdialysis was performed to measure glucose, lactate, pyruvate and glycerol intraperitoneally and subcutaneously. The lactate/pyruvate ratio was calculated.Results: The lactate/pyruvate ratio did not differ between the groups. In the diabetic patients, glucose levels were higher intraperitoneally at both Days 1 and 2 compared to controls. Higher glycerol levels were found subcutaneously in obese patients at Day 2. CONCLUSIONS: The lactate/pyruvate ratio does not increase intraperitoneally after non-complicated major abdominal surgery in diabetic and obese patients. Obese patients have increased release of free fatty acids and glycerol subcutaneously, while diabetic patients show higher glucose levels intraperitoneally than controls.
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| 8. |
- Jörgren, Fredrik, et al.
(författare)
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Oncological outcome after incidental perforation in radical rectal cancer surgery
- 2010
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Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 25:6, s. 731-740
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Tidskriftsartikel (refereegranskat)abstract
- Identification of risk factors of poor oncological outcome in rectal cancer surgery is of utmost importance. This study examines the impact of incidental perforation on the oncological outcome. Using the Swedish Rectal Cancer Registry, patients were selected who received major abdominal surgery for rectal cancer between 1995 and 1997 with registered incidental perforation. A control group was also selected for analysis of the oncological outcome after 5-year follow-up. Multivariate analysis was performed. Registry data were validated, and additional data were supplemented from medical records. After validation and exclusion of non-radically operated patients, 118 patients with incidental perforation and 155 controls in TNM stages I-III were included in the analysis. The rate of local recurrence (LR) [20% (23/118) vs. 8% (12/155) (p = 0.007)] was significantly higher among patients with perforation, whereas the rates of distant metastasis [27% (32/118) vs. 21% (33/155) (p = 0.33)] and overall recurrence (OAR) [35% (41/118) vs. 25% (38/155) (p = 0.087)] were not significantly different between the groups. Overall as well as cancer-specific 5-year survival rates were significantly reduced for the patients with perforation [44 vs. 64% (p = 0.002) and 66 vs. 80% (p = 0.026), respectively]. In the multivariate analysis, perforation was a significant risk factor of increased rates of LR and OAR as well as reduced 5-year overall and cancer-specific survival. Incidental perforation in rectal cancer surgery is an important risk factor of poor oncological outcome and should be considered in the discussion concerning postoperative adjuvant treatment as well as the follow-up regime.
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| 9. |
- Ehrsson, Ylva Tiblom, et al.
(författare)
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Explorative study on the predictive value of systematic inflammatory and metabolic markers on weight loss in head and neck cancer patients undergoing radiotherapy
- 2010
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Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 18:11, s. 1385-1391
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study aimed to explore the predictive value of systematic inflammatory and metabolic markers in head and neck (H&N) cancer patients during radiotherapy (RT). Methods Twenty-seven patients were evaluated. The protocol included serial blood tests [highly sensitive C-reactive protein (hsCRP), albumin, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1) and ghrelin], measurements of body weight and assessment of oral mucositis. Results The mean nadir of weight loss was observed at the end of RT. At the time of diagnosis, mean hsCRP was 5.2 +/- 1.0 mg/L. HsCRP significantly increased during RT and decreased during the post-RT period. Mean maximum hsCRP was 35.8 +/- 8.5 mg/L, with seven patients reaching >40 mg/L. A numerical decrease of albumin (by 18.2%) and only small changes in IGF-1, IGFBP-1 and ghrelin levels were observed. None of the metabolic parameters was significantly associated with weight loss. Conclusions HsCRP increased in response to RT for H&N cancer as a sign of irradiation-induced inflammation. Weight loss was not preceded by changes of the metabolic parameters, indicating that assessment of the blood markers used in this study is of little value. Regular body weight measurement and assessment of oral mucositis are feasible, cheap and important procedures to control the metabolic homeostasis during RT.
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