Risk factors for right colon, left colon and rectal cancers differ between men and women: the population-based HUNT study in Norway.

AIM: The aim of this study was to assess established risk factors for colorectal cancer (CRC) separately for right colon, left colon and rectal cancer in men and women. METHOD: This was a prospective cohort study comparing incidental CRC cases and the general population participating in a longitudinal health study in Norway (the HUNT study). RESULTS: Among 78 580 participants (36 825 men and 41 754 women), 1827 incidental CRCs were registered (931 men and 896 women). Among men, the risk of cancer at all locations increased with age [HR 1.46 (1.40-1.51), HR 1.32 (1.27-1.36), HR 1.30 (1.25-1.34) per 5 years for right colon, left colon and rectal cancer, respectively] and the risk of left colon cancer increased with higher body mass index [HR 1.28 (1.12-1.46) per 5 kg/m2 ]. The risk of right colon cancer (RCC) increased with smoking [HR 1.07 (1.04-1.10) per 5 pack years]. Among women, the risk of cancer at all locations increased with age [HR 1.38 (1.34-1.43), HR 1.23 (1.19-1.27), HR 1.20 (1.16-1.24) per 5 years] and smoking [HR 1.07 (1.02-1.12), HR 1.07 (1.02-1.12), HR 1.10 (1.05-1.17) per 5 pack years] for right colon, left colon and rectal cancer, respectively. The risk of RCC increased with night shift work [HR 1.93 (1.22-3.05)]. CONCLUSION: The risk factors for developing CRC differ by anatomical location and sex. The relationship between risk factors and CRC may be more nuanced than previously known.

Octogenarian patients with colon cancer - postoperative morbidity and mortality are the major challenges.

BACKGROUND: Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. METHODS: All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. RESULTS: Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time. CONCLUSION: Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.

The impact of age on rectal cancer treatment, complications and survival.

BACKGROUND: The number of older patients with rectal cancer is increasing. Treatment outcome discrepancies persist, despite similar treatment guidelines. To offer the oldest patients optimal individually adjusted care, further knowledge is needed regarding treatment strategy and outcome. The present study aimed to evaluate treatment, postoperative complications, and survival in older patients treated for rectal cancer. METHODS: This retrospective study included all 666 patients (n=255 females, n=411 males) treated for rectal cancer at Levanger Hospital during 1980-2016 (n=193 <65 years, n=329 65-79 years, n=144 ≥80 years). We performed logistic regression to analyse associations between complications, 90-day mortality, and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. RESULTS: Despite a similar distribution of cancer stages across age-groups, patients aged ≥80 years were treated with a non-curative approach more frequently than younger age groups. Among patients aged ≥80 years, 42% underwent a non-curative treatment approach, compared to 25% of patients aged <65 years, and 25% of patients aged 65-79 years. The 90-day mortality was 15.3% among patients aged ≥80 years, compared to 5.7% among patients aged <65 years, and 9.4% among patients aged 65-79 years. Among 431 (65%) patients treated with a major resection with curative intent, the 90-day mortality was 5.9% among patients aged ≥80 years (n=68), compared to 0.8% among patients aged <65 years (n=126), and 3.8% among patients aged 65-79 years (n=237). The rate of postoperative complications was 47.6%. Pneumonia was the only complication that occurred more frequently in the older patient group. The severity of complications increased with three factors: age, American Society of Anaesthesiologists score, and >400 ml perioperative blood loss. Among patients that survived the first 90 days, the relative long-term survival rates, five-year local recurrence rates, and metastases rates were independent of age. CONCLUSION: Patients aged ≥80 years were less likely to undergo a major resection with curative intent and experienced more severe complications after surgery than patients aged <80 years. When patients aged ≥80 years were treated with a major resection with curative intent, the long-term survival rate was comparable to that of younger patients.

Long-term trends in colorectal cancer: incidence, localization, and presentation.

BACKGROUND: The purpose of this study was to assess trends in incidence and presentation of colorectal cancer (CRC) over a period of 37 years in a stable population in Mid-Norway. Secondarily, we wanted to predict the future burden of CRC in the same catchment area. METHODS: All 2268 patients diagnosed with CRC at Levanger Hospital between 1980 and 2016 were included in this study. We used Poisson regression to calculate the incidence rate ratio (IRR) and analyse factors associated with incidence. RESULTS: The incidence of CRC increased from 43/100,000 person-years during 1980-1984 to 84/100,000 person-years during 2012-2016. Unadjusted IRR increased by 1.8% per year, corresponding to an overall increase in incidence of 94.5%. Changes in population (ageing and sex distribution) contributed to 28% of this increase, whereas 72% must be attributed to primary preventable factors associated with lifestyle. Compared with the last observational period, we predict a further 40% increase by 2030, and a 70% increase by 2040. Acute colorectal obstruction was associated with tumours in the left flexure and descending colon. Spontaneous colorectal perforation was associated with tumours in the descending colon, caecum, and sigmoid colon. The incidence of obstruction remained stable, while the incidence of perforation decreased throughout the observational period. The proportion of earlier stages at diagnosis increased significantly in recent decades. CONCLUSION: CRC incidence increased substantially from 1980 to 2016, mainly due to primary preventable factors. The incidence will continue to increase during the next two decades, mainly due to further ageing of the population.

Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study.

BACKGROUND: Studies from several countries indicate that the incidence and mortality of bloodstream infection (BSI) have been increasing over time. METHODS: We studied the burden of disease and death related to BSI in a defined geographical area of Mid-Norway, where BSI episodes were prospectively recorded by the same microbiological department during 12 consecutive years. Death from BSI was defined as death within 30 days of BSI detection. Age and sex standardized incidence and mortality rates and case fatality rates were calculated. RESULTS: Between 2002 and 2013, 1995 episodes of BSI in 1719 patients aged 16 to 99 years were included. The overall incidence of BSI was 215 per 100,000 person-years. The incidence increased exponentially with age, particularly in males. The incidence increased from 205 to 223 per 100,000 person-years from 2002-07 to 2008-13. Escherichia coli was the most frequently isolated infective agent, followed by Streptococcus pneumoniae and Staphylococcus aureus. The rate of S. pneumoniae BSI decreased over time in males (on average by 9.2% annually), but not in females. The total rate of BSI microbes with acquired resistance increased slightly over time, but did not exceed 2 episodes per 100,000 person-years. The mortality of BSI was 32 per 100,000 person-years, higher in males than in females (36 vs. 28 per 100,000 person-years) and was significantly higher in old age, particularly in males. The total BSI mortality was similar in the first and second halves of the study period, but the mortality of S. pneumoniae BSI decreased in males (15.0% annually). The crude case fatality decreased from the first to the second half of the study period (17.2% to 13.1%; p = 0.014). The rate of blood culture sampling increased more than twofold during the study period. CONCLUSIONS: The mortality of BSI remained stable during 2002-2013. At the same time, BSI incidence increased and case fatality rate decreased, perhaps because an increased rate of blood culture sampling may have led to improved detection of milder BSI episodes. Very low, yet slightly increasing rates of microbes with acquired resistance were observed.

Trends in antimicrobial resistance and empiric antibiotic therapy of bloodstream infections at a general hospital in Mid-Norway: a prospective observational study.

BACKGROUND: The occurrence of bloodstream infection (BSI) and antimicrobial resistance have been increasing in many countries. We studied trends in antimicrobial resistance and empiric antibiotic therapy at a medium-sized general hospital in Mid-Norway. METHODS: Between 2002 and 2013, 1995 prospectively recorded episodes of BSI in 1719 patients aged 16-99 years were included. We analyzed the antimicrobial non-susceptibility according to place of acquisition, site of infection, microbe group, and time period. RESULTS: There were 934 community-acquired (CA), 787 health care-associated (HCA) and 274 hospital-acquired (HA) BSIs. The urinary tract was the most common site of infection. Escherichia coli was the most frequently isolated infective agent in all three places of acquisition. Second in frequency was Streptococcus pneumoniae in CA and Staphylococcus aureus in both HCA and HA. Of the BSI microbes, 3.5% were non-susceptible to the antimicrobial regimen recommended by the National Professional Guidelines for Use of Antibiotics in Hospitals, consisting of penicillin, gentamicin, and metronidazole (PGM). In contrast, 17.8% of the BSI microbes were non-susceptible to cefotaxime and 27.8% were non-susceptible to ceftazidime. Antimicrobial non-susceptibility differed by place of acquisition. For the PGM regimen, the proportions of non-susceptibility were 1.4% in CA, 4.8% in HCA, and 6.9% in HA-BSI (p < 0.001), and increasing proportions of non-susceptibility over time were observed in HA-BSI, 2.2% in 2002-2005, 6.2% in 2006-2009, and 11.7% in 2010-2013 (p = 0.026), mainly caused by inherently resistant microbes. We also observed increasing numbers of bacteria with acquired resistance, particularly E. coli producing ESBL or possessing gentamicin resistance, and these occurred predominantly in CA- and HCA-BSI. CONCLUSIONS: Generally, antimicrobial resistance was a far smaller problem in our BSI cohort than is reported from countries outside Scandinavia. In our cohort, appropriate empiric antibiotic therapy could be achieved to a larger extent by replacing second- and third-generation cephalosporins with penicillin-gentamicin or piperacillin-tazobactam.

Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993-2010.

BACKGROUND: The Norwegian Rectal Cancer Project was initated in 1993 with the aims of improving surgery, decreasing local recurrence rates, improving survival, and establishing a national rectal cancer registry. Here we present results from the Norwegian Colorectal Cancer Registry (NCCR) from 1993 to 2010. MATERIAL AND METHODS: A total of 15 193 patients were diagnosed with rectal cancer in Norway 1993-2010, and were registered with clinical data regarding diagnosis, treatment, locoregional recurrences and distant metastases. Of these, 10 796 with non-metastatic disease underwent tumour resection. The results were stratified into five time periods, and the treatment outcomes were compared. Recurrence rates are presented for the 9785 patients who underwent curative major resection (R0/R1). RESULTS: Among all 15 193 patients, relative five-year survival increased from 54.1% in 1993-1997 to 63.4% in 2007-2010 (p < 0.001). Among the 10 796 patients with stage I-III disease who underwent tumour resection, from 1993-1997 to 2007-2010, relative five-year survival improved from 71.2% to 80.6% (p < 0.001). An increasing proportion of these patients underwent surgery at large-volume hospitals; and 30- and 100-day mortality rates, respectively, decreased from 3.0% to 1.4% (p < 0.001) and from 5.1% to 3.0% (p < 0.011). Use of preoperative chemoradiotherapy increased from 6.5% in 1993 to 39.0% in 2010 (p < 0.001). Estimated local recurrence rate after major resection (R0/R1) decreased from 14.5% in 1993-1997 to 5.0% in 2007-2009 (p < 0.001), and distant recurrence rate decreased from 26.0% to 20.2% (p < 0.001). CONCLUSION: Long-term outcomes from a national population-based rectal cancer registry are presented. Improvements in rectal cancer treatment have led to decreased recurrence rates of 5% and increased survival on a national level.

Trends in cholecystectomy rates in a defined population during and after the period of transition from open to laparoscopic surgery.

OBJECTIVE: To evaluate cholecystectomy rates in a Norwegian county during the transition time from open to laparoscopic surgery, with focus on the incident rate of laparoscopic operations, sex differences, age at operation, and indications for cholecystectomy. MATERIAL AND METHODS: All 2615 patients living in North Trondelag County and operated with cholecystectomy for benign biliary disease between 1990 and 2011 were identified. Poisson regression was used to analyze factors associated with cholecystectomy incidence rate ratios (IRRs). RESULTS: The proportion of completed laparoscopic cholecystectomies was 8% in 1992, 50% in 1994, 94% in 2003 and 99% in 2011. The incidence of cholecystectomy increased from 6.2 per 10 000 person-years in 1990-1992, 8.0 in 1993-1997, to 10.0 in 1998-2003 and remained at this level with a rate of 10.7 during 2004-2011. Adjusting for age at each year of surgery the IRR for females compared with males was 2.3(2.1-2.5) p < 0.001. The median age at operation was 60.2 years (13-90) in males, 50.1 years (12-93) in females p < 0.001. The median age diminished by 5 years in both males and females. A conversion from laparoscopic to open surgery decreased significantly by calendar year of surgery, increased with age of the patient, and was less often in surgery for gallstone colic than for other indications. CONCLUSIONS: During the introduction of laparoscopic surgery, the rates of cholecystectomy increased and remained stable at a higher level during the later years of the study. The rate of completed laparoscopic operations increased from 8% in 1992 to 99% in 2011.

Survival after acute colon diverticulitis treated in hospital.

PURPOSE: The aim of this study was to determine the short- and long-term relative survival as well as the causes of death in patients treated in hospital for acute colonic diverticulitis. MATERIALS AND METHODS: The study included all patients treated at Levanger Hospital for acute colonic diverticulitis between 1988 and 2012. Vital statistics were complete. The median observation time was 6.95 years (range 0.28-24.66) or until death. RESULTS: In total, 650 different patients were hospitalized with acute colonic diverticulitis. Among these patients, there were 851 admissions for the same disease during the 25 years. The admissions had the following diagnoses: simple diverticulitis, 738; abscess formation , 44; perforation and purulent peritonitis, 47; perforation and fecal peritonitis, 9; and intestinal obstruction, 13. During the observation time, 219 were dead and 431 were still alive. After the first admission, the 100 day relative survival in patients with uncomplicated diverticulitis was 97 % (CI 95 to 99), with abscess formation 79 % (62 to 89), with purulent peritonitis 84 % (69 to 92), with fecal peritonitis 44 % (10 to 74), and with intestinal obstruction 80 % (38 to 96). After surviving the first 100 days, the estimated 5-year relative survival in the remaining 609 patients was 96 % (CI 92 to 100) and 10-year survival was 91 % (CI 84 to 97). In patients who survived the first 100 days, the different subtypes of diverticulitis yielded no significant differences in long-term relative survival. All patients who had been admitted with ASA score 4 were dead after 2 years.

Major increase in admission- and incidence rates of acute colonic diverticulitis.

PURPOSE: Hospitalization for acute colonic diverticulitis has become more and more frequent. We studied the changes in the rate of admission and incidence of the disease during the last 25 years. METHODS: We performed a retrospective analysis of all cases treated for acute diverticulitis during 1988-2012 at one hospital serving a defined population in Mid-Norway. The study made a distinction between admission rates and incidence rates. The admission rates defined the total number of cases admitted, while the incidence rates defined the number of new patients hospitalized for acute diverticulitis (first admission). Poisson regression was used to analyse factors associated with diverticulitis incidence rates. RESULTS: A total of 851 admissions in 650 different patients were identified, with an overall admission rate of 38.5 (CI 35.9 to 41.1) per 100,000 person-years. The admission rate increased from 17.9 (CI 14.1 to 22.3)/100,000 during 1988-1992 to 51.1 (CI 44.8 to 58.0)/100,000 during 2008-2012. Poisson regression analysis showed a significant increase in admission rates with a factor of 2.8 (C.I. 2.2 to 3.5) during 25 years. The overall incidence rate (IRR) of new patients was 29.4 (CI 27.1 to 31.7)/100,000 person-years. IRR increased significantly with a factor of 2.6 (CI 1.96 to 3.34) during 25 years, while IRR for perforations increased even more, by a factor of 3.3 (CI 1.24 to 8.58). CONCLUSION: The hospital admission rates as well as incidence rates for acute colonic diverticulitis increased significantly during the 25-year time span.

Violation of treatment guidelines -- hazard for rectal cancer patients.

AIM: The aim of this study was to evaluate temporal trends in treatment and outcome in rectal cancer diagnosed during 1980-2004 at Levanger Hospital. MATERIALS AND METHODS: A protocol for prospective registration of rectal cancer treated with total mesorectal excision including operative strategy, radiotherapy and surveillance was established at Levanger Hospital in 1980. In this study, all rectal cancer patients treated during 1980-2004 were included. RESULTS: More patients received preoperative radiotherapy during 2000-2004, but otherwise there were no significant differences in presentation or treatment during 1980-2004. The 5-year local recurrence rate after resection with curative intent was 4.5% (0-9.7), 18.7% (10.3-27.1) and 2.2% (0-6.7) in 1980-1989, 1990-1999 and 2000-2004 (p = 0.006), respectively. Out of a total of 23 cases of local recurrence, treatment guidelines, mainly with regard to radiotherapy, were violated in 19 cases. The 5-year overall survival after resection with curative intent was 65% (95% confidence interval [CI] 55-76) during 1980-1989, 58% (49-68) in 1990-1999 and 71% (59-83) in 2000-2004 (n.s). The 5-year relative survival was 83% (95% CI 69-95) during 1980-1989, 71% (59-81) in 1990-1999 and 84% (69-98) in 2000-2004 (n.s). CONCLUSION: Rectal cancer patients experienced excellent outcomes in the period 1980-1989 and 2000-2004. Due to violations of treatment guidelines, the rate of local recurrence was much too high in the period 1990-1999. This article illustrates the importance of continuous quality assurance in the treatment of rectal cancer to maintain optimized outcomes for the patients.

Prevalence of anaemia at diagnosis of colorectal cancer: assessment of associated risk factors.

BACKGROUND/AIMS: The aim of this study was to report the prevalence of anaemia in patients with cancer located in different anatomical segments of the colon and rectum and to assess possible risk factors for this anaemia. METHODOLOGY: The study included 1189 patients referred during 1980-2004 with a colorectal adenocarcinoma. Data were obtained from hospital records and from the Norwegian Cancer Registry. Risk factors for anaemia were analyzed in multivariable logistic regression analysis. The WHO definition of anaemia was used. RESULTS: The prevalence of anaemia diminished gradually and linearly as the location of the tumours was more distal towards the rectum. Anaemia was found in 74.7% (215/288) of the patients with cancer in the coecum or ascending colon, 57.1% (48/84) in the transverse colon, 40.0% (180/300) in the sigmoid and 30.5% (114/374) in the rectum. In the multivariable analysis, age, location of the tumour and T-stage remained associated with anaemia, whereas the histological differentiation of the tumour, N-stage, M-stage, period of admission, duration of symptoms and rectal bleeding were not. CONCLUSIONS: Anaemia was common, especially in patients with proximal colon cancer. T-stage but not N-stage or M-stage was associated with anaemia.

Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years.

BACKGROUND: The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease. AIM: To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years. METHODS: This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades. RESULTS: Two hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades. CONCLUSION: Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.

Quality of life and psychological and gastrointestinal symptoms after cholecystectomy: a population-based cohort study.

OBJECTIVE: The study aims to examine gastrointestinal symptoms, quality of life and the risk of psychological symptoms after cholecystectomy. DESIGN: This is a prospective population-based cohort study based on the Nord-Trøndelag Health Study (HUNT) Norway. HUNT is a repeated health survey of the county population and includes a wide range of health-related items. In the present study, all 3 HUNT surveys were included, performed between 1984 and 2008. Selected items were scores on quality of life, the Hospital Anxiety and Depression Scale (HADS) and selected gastrointestinal symptoms. Participants who underwent cholecystectomy for gallstone disease between 1 January 1990 and until 1 year before attending HUNT3 were compared with the remaining non-operated cohort. Associations between cholecystectomy and the postoperative scores and symptoms were assessed by multivariable regression models. RESULTS: Participants in HUNT1, HUNT2 and HUNT3 were 77 212 (89.4% of those invited), 65 237 (69.5%) and 50 807 (54.1%), respectively. In the study period, 931 participants were operated with cholecystectomy. Cholecystectomy was associated with an increased risk of diarrhoea and stomach pain postoperatively. In addition, cholecystectomy was associated with an increased risk of nausea postoperatively in men. We found no associations between cholecystectomy and quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation following surgery. CONCLUSIONS: In this large population-based cohort study, cholecystectomy was associated with postoperative diarrhoea and stomach pain. Cholecystectomy for gallstone colic was associated with nausea in men. There were no associations between quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation.

Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway.

AIM: To assess risk factors of hospital admission for acute colonic diverticulitis. METHODS: The study was conducted as part of the second wave of the population-based North Trondelag Health Study (HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants (65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436 (52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR. RESULTS: Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity (body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present (HR = 2.11, P < 0.001) or previous (HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness (HR = 2.57, P < 0.001) and living in rural areas (HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis. CONCLUSION: The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.

Abdominal surgery for Crohn's disease during 30 years in Middle Norway.

BACKGROUND/AIMS: The aim of the study was to analyze the annual incidence of laparotomy for Crohn's disease in a defined population in Middle Norway. We also wanted to assess the feasibility of the new Vienna classification of Crohn's disease in this pure surgical material. METHODOLOGY: We conducted a retrospective study of 102 consecutive abdominal operations for Crohn's disease in 74 patients. Age at onset, disease behavior and location were classified according to the recent Vienna classification. The median follow-up after the primary operation was 6.2 years (0.5-25.1 years). RESULTS: The number of operations increased for every 5-year period: The corresponding annual incidence rates for primary operations from 1975 were 0.2, 1.9, 3.3, 4.7 and 5.4 per 100,000 inhabitants. The Vienna classification divided this purely surgical material into meaningful groups. CONCLUSIONS: The study demonstrated a steady increase in laparotomies for Crohn's disease in our area during the study period.

[Acute gallstone pancreatitis--when should the clearance of biliary tract be performed?]. / Akutt gallesteinspankreatitt--når skal galleveiene saneres?

BACKGROUND: On the basis of a 19-year material we discuss early or delayed surgery for definitive clearance of the biliary tract after acute gallstone pancreatitis. MATERIAL AND METHODS: During 1980-98, 218 patients, 133 women and 85 men, median age 69.5 years (16-96 years) with acute gallstone pancreatitis were treated at Levanger hospital, Norway. During 1980-89 (period 1), 111 patients were mainly treated by open operations as soon as the acute pancreatitis had settled, while during 1990-98 (period 2), 107 patients were mainly treated conservatively and the biliary operations performed laparoscopically/endoscopically later. RESULTS: In period 1 two patients died, one of them after open surgery (2%). In period 2 four patients died. 21 patients were readmitted due to a new attack, two of whom died. Two patients developed acute cholecystitis. INTERPRETATION: Early surgery for the gallstone disease in patients with acute gallstone pancreatitis is well tolerated, recurrent attacks are rare and the mortality low.

[Treatment of acute pancreatitis]. / Behandling av akutt pankreatitt.

BACKGROUND: The role of surgery in the treatment of acute pancreatitis is still unclear. The aim of this study was to evaluate and compare our results with different treatment strategies described in the literature. MATERIAL AND METHODS: From 1980 to 1998, 376 patients, 195 women and 181 men, median age of 62.5 years (15-96 years) with acute pancreatitis were treated in our hospital. The classification of the pancreatitis was based on Ranson signs (more than four defined as serious). Patients with septic necrosis/abscesses were treated with percutaneous drainage and irrigation. RESULTS: The disease was caused by gallstone in 58%, ethyl in 13%, unknown cause in 14%, and miscellaneous in 15%. In 50 patients (13%) the pancreatitis was serious. Ten patients (2.6%) died in hospital. Among all patients with serious/haemorrhagic pancreatitis the mortality was 18%. INTERPRETATION: Intensive supportive care and broad spectrum antibiotics combined with percutaneous drainage and irrigation of infected intraabdominal content in haemorrhagic pancreatitis seem to give the same results as open surgery.