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.

[Colonic ileus. Treatment of colonic ileus, a 10-year patient material]. / Colonileus. Behandling af colonileus, et tiårigt materiale.

Morbidity and mortality have been evaluated in 238 patients with acute large bowel obstruction admitted over a ten year period. In two thirds, the cause of obstruction was a primary colonic carcinoma. Most of these patients (61%) had advanced disease and were over 70 years of age. Volvulus and cancer recurrences each accounted for 10%, and diverticulitis for eight percent. An overall mortality of 24% was found. Of 115 patients who had the obstructing lesion--primary carcinoma or diverticulitis--resected, a mortality of 8.7 was seen, higher for primary (14.9%) than for staged (4.4%) resections, in contrast the latter had a significantly longer hospital stay, 30 days as against 17 days when a primary resection was performed. Six non-lethal anastomotic leaks occurred. It is concluded, that patients with large bowel obstruction, most often caused by a colorectal carcinoma, are a high-risk group. In this retrospective study staged procedure compared with primary resection had lowest morbidity and mortality.

[Undescended testis treated by intranasal application of luteinizing hormone-releasing hormone (LH-RH)]. / Non-descensus testis behandlet med intranasalt appliceret luteiniserende hormon/frigørende (releasing) hormone (LH-RH).

In a double-blind, placebo-controlled study, 118 boys, aged 2-12 years, with 161 undescended testes were treated with luteinising-hormone releasing-hormone (LH-RH), 1.2 mg daily intranasally for four weeks. According to randomization, 60 boys with 85 undescended testes received LH-RH and 58 boys with 76 undescended testes received the placebo. 17 testes (20%) in 12 boys (20%) descended in the LH-RH group and 2 testes (3%) in 2 boys (3%) descended in the placebo group. This difference is statistically significant (chi 2, 0.01 greater than p greater than 0.001). A second LH-RH course, offered three months later to the boys who did not respond to the first LH-RH course, increased the success rate to 35%. The primary location of the testis was a significant factor for the effect of treatment. The highest success rate (63%) was registered in testes located in a high scrotal position. There was no significant difference in success of treatment between unilateral and bilateral cryptorchidism, nor between age groups. No serious adverse effects of treatment were noted. It is concluded, that LH-RH administered intranasally can be used in the treatment of boys with unilateral and bilateral cryptorchidism.

[Recurrence and survival after conventional low anterior resection for rectal cancer]. / Recidiv og overlevelse efter konventionel lav anterior resektion for cancer recti.

INTRODUCTION: The aim of the study was to evaluate the incidence of recurrence of local cancer, distant metastases and survival after conventional low anterior resection for cure in patients with rectal carcinoma, on the basis of the poor prognosis after colorectal cancer in Denmark. MATERIAL AND METHODS: Consecutive patients operated on in the nine Danish departments of surgical gastroenterology in 1992-1993. Retrospective collection of data on recurrence of local cancer, distant metastases, and over-all survival at the end of 1996. RESULTS: Of 268 patients, 77 (29%) developed recurrent local cancer and/or distant metastases. Forty-eight (18%) had local recurrence with a cumulative 5-year rate of 39%. Distant metastases were seen in 54 (20%). The local recurrence rate increased with increasing Dukes' tumour stage and was higher after operation by a non-specialist (30%) than by a consultant, another specialist, or a surgeon under training and supervised by a consultant (15-17%) (p = 0.04). Multiple regression showed that the recurrence rate was independent of tumour localisation, blood loss, transfusion, anastomotic leakage, and status of the surgeon. The cumulative crude 5-year survival was 50% and independent of the status of the surgeon. DISCUSSION: Our relatively high local recurrence rate and the results in the literature after total mesorectal excision (TME) indicate that the conventional technique should be replaced by TME, which has become the recommended method in recent years. Furthermore, we propose a changed strategy in the treatment of rectal cancer. The patients should be treated in fewer departments with established teams of rectal cancer specialists taking part in all operations for rectal cancer.

Trends in colorectal cancer survival in northern Denmark: 1985-2004.

OBJECTIVE: The prognosis for colorectal cancer (CRC) is less favourable in Denmark than in neighbouring countries. To improve cancer treatment in Denmark, a National Cancer Plan was proposed in 2000. We conducted this population-based study to monitor recent trends in CRC survival and mortality in four Danish counties. METHOD: We used hospital discharge registry data for the period January 1985-March 2004 in the counties of north Jutland, Ringkjøbing, Viborg and Aarhus. We computed crude survival and used Cox proportional hazards regression analysis to compare mortality over time, adjusted for age and gender. A total of 19,515 CRC patients were identified and linked with the Central Office of Civil Registration to ascertain survival through January 2005. RESULTS: From 1985 to 2004, 1-year and 5-year survival improved both for patients with colon and rectal cancer. From 1995-1999 to 2000-2004, overall 1-year survival of 65% for colon cancer did not improve, and some age groups experienced a decreasing 1-year survival probability. For rectal cancer, overall 1-year survival increased from 71% in 1995-1999 to 74% in 2000-2004. Using 1985-1989 as reference period, 30-day mortality did not decrease after implementation of the National Cancer Plan in 2000, neither for patients with colon nor rectal cancer. However, 1-year mortality for patients with rectal cancer did decline after its implementation. CONCLUSION: Survival and mortality from colon and rectal cancer improved before the National Cancer Plan was proposed; after its implementation, however, improvement has been observed for rectal cancer only.

Surgical treatment of acute malignant large bowel obstruction.

OBJECTIVE: To evaluate the morbidity and mortality in all patients operated on urgently for acute large bowel obstruction caused by carcinoma of the colon or rectum during a 10 year period. DESIGN: Retrospective study. SETTING: Aalborg Hospital, Denmark. SUBJECTS: 156 consecutive patients operated on for obstructing primary colorectal cancers. MAIN OUTCOME MEASURES: Operations done, morbidity and mortality. RESULTS: 95 patients (61%) had advanced disease (Dukes' stage C or "D") and their median age was 73 years (range 38-93). 97 had the obstructing lesion resected with a 30 day mortality of 5%. 43 patients underwent primary resection and 4 died (9%), and 54 underwent staged resection with one death (2%). Complications were common, particularly after staged resections, median hospital stay being 19 days after primary, compared with 30 days after staged resection. 59 patients (38%) had palliative operations with 29 deaths (49%); in 39 the tumor was completely unresectable. CONCLUSION: Patients with obstructing primary colorectal cancers are a high risk group who are characterised by advanced disease and old age. Only prospective trials comparing different operations can assess whether it is possible to achieve a reduction in mortality.

Effects of nifedipine on spontaneous and methylergometrine-induced activity post partum.

Intrauterine pressure changes were recorded by microtransducer catheter in 17 women immediately post partum. In all patients, spontaneous contractile activity was recorded, characterized by high contraction amplitudes (110 to 350 mm Hg). The calcium entry blocker nifedipine effectively inhibited these contractions. Both in vitro, in strips of pregnant myometrium, and in vivo, methylergometrine induced a contractile activity that could be blocked by nifedipine. The conclusion is that, for the testing of drugs that affect the contractile activity of pregnant myometrium, the use of intrauterine pressure recording by microtransducer catheters in the early postpartum period provides a suitable model.

Irrigation during vasectomy: a comparison between sterile water and the spermicide euflavine.

In a randomized, double-blind investigation 36 men undergoing sterilization had irrigation of the vas deferens with either sterile water or the spermicide, euflavine, to reduce the lag to sterility. Semen samples were vital stained by the patients shortly after ejaculation and the smears were mailed to the laboratory. Irrigation with the spermicide was significantly more effective than sterile water. However, even in the group irrigated with euflavine 6 to 35 days elapsed before the semen samples were without potentially fertile spermatozoa.

PIP: A randomized double-blind investigation compared the irrigation of vas deferens with sterile water or the spermicide euflavine. The irrigating fluid was either 5 ml 1/00 aqueous euflavine through each vas or 3 times 5 ml sterile water with 1-2 minute intervals through each vas. Then 0.5-1 cm of vas deferens was resected and ligated with 3 zero sutures, and the cut ends of vas were separated by the fascia. Smears from semen samples were mailed every 2 weeks. 2 consecutive azoospermic samples indicated that sterility was achieved and specimens were no longer submitted. Staining was performed by the patient and smears were mailed in airtight plastic bags along with a tablet of dessicating agent. Those spermatozoa which were completely stained red were considered as infertile, while partially stained or unstained spermatozoa were considered as potentially fertile. Irrigation with euflavine was far more effective than with water--the number of days and the number of ejaculations until the last ejaculate with potentially fertile spermatozoa, the 1st ejaculate without potentially fertile spermatozoa, and subsequent azoospermia. The 1st ejaculate without unstained spermatozoa averaged 11 with sterile water and 5.5 with euflavine. The median number of ejaculates to achieve azoospermia was 16 with sterile water and 12 with euflavine. There were no spontaneous recanalizations and there were no complaints indicative of prostato-vesiculitis or hematospermia. With the euflavine, 6-35 days elapsed before semen were without potentially fertile spermatozoa. While it is not ideal, euflavine is more efficient as an irrigating agent.

Effects of nifedipine on oxytocin- and prostaglandin F2 alpha -induced activity in the postpartum uterus.

In order to get additional information on spontaneous and drug-induced uterine activity in the early postpartum period, intrauterine pressure was registered by the microtransducer technique in 19 patients. The effects of the calcium entry blocker nifedipine were also tested. Myometrial activity was induced by infusion of oxytocin (10 patients) or prostaglandin F 2 alpha (nine patients). Both hormones increased myometrial activity, with slightly different patterns of contractility. Nifedipine effectively reduced contractions induced by both drugs. The microtransducer technique seems to be a convenient and safe method for studying the effects of drugs and hormones on uterine activity post partum. Furthermore, nifedipine administered orally is a potent inhibitor of drug-induced myometrial activity in the early postpartum period.

Plasma norepinephrine is abnormal in patients with duodenal ulcer. The significance of age.

Previous studies indicate that the forearm venous plasma norepinephrine (NE) concentration is abnormally high in patients with duodenal ulcer. The aim of the present study was to examine the relationship between age and plasma NE concentration in patients with duodenal ulcer and controls. Eleven male patients with duodenal ulcer and 12 male control subjects were examined. Plasma NE concentration was approximately twofold greater in duodenal ulcer patients in both the resting seated position and during exercise than values obtained in controls (2 p less than 0.02, less than 0.05). There was a strong correlation between plasma NE and age in patients with duodenal ulcer but not in controls (r = 0.69, 2 p less than 0.05). Our results suggest that the increase in plasma NE with age is greater in patients with duodenal ulcer than in normal healthy subjects or in patients with minor surgical diseases. Patients with duodenal ulcer may have a higher functional age than healthy subjects.

The effect of previous blood transfusion on lymphocyte subsets and natural killer cell function in patients with colorectal cancer.

To elucidate the possible influence of previous blood transfusion on immune functions, the transfusion history of 153 patients admitted to hospital for elective colorectal surgery was correlated with lymphocyte subsets and natural killer (NK) cell function. The subsets determined were CD2, CD3, CD4, CD8, CD16, CD20, CD56, CD57 and HLA-DR-positive. The NK cell function was determined by measuring the killing capacity against cFDA-labelled K562 target cells monitored via a flow-cytometer. We found that 42 patients (27%) had been transfused before surgery, of these 13 had been transfused less than 30 days before surgery and 29 (19%) transfused more than 30 days before (median 10 years, range 0.1-37 years). In transfused patients, we found a significantly reduced number of B lymphocytes (CD20; p = 0.01), a reduction in HLA-DR-positive cells (p = 0.02) and a just significant reduction of NK cell function in transfused compared to nontransfused patients. The reduction in NK cell function is marginal and the NK cell function is within normal range, and probably without clinical significance. Reduction in NK cell function has been described before, whereas the reduction in B cells has not been reported earlier. The results may suggest an impaired humoral immunity and a minor reduction in cellular immunity in patients following blood transfusion.

Leukocyte filtration does not affect lymphocyte subpopulations and NK cell function in recipients of blood transfusions.

BACKGROUND AND OBJECTIVES: The possible immunosuppressive action of blood transfusion has aroused great interest recently, particularly with respect to its effects on tumor growth and recurrence rate of malignant disease. MATERIALS AND METHODS: The effect of blood transfusion on lymphocyte subpopulations and NK cell function preoperatively and 6 months postoperatively was studied in 129 patients treated with elective surgery for colorectal malignancy. Forty-two patients (33%) received blood transfusions, 21 of them randomly allocated to receive leukocyte-depleted blood products. Investigation was by means of conventional laboratory methods. RESULTS: In 21 patients receiving a median of 3 units of non-leukocyte-depleted blood products (NLD), a significant reduction in CD4+ lymphocytes (44% vs. 40%, p < 0.01) occurred. In contrast, no significant changes in CD4+ lymphocytes were observed in the 21 patients transfused with leukocyte-depleted blood products (LD). However, with respect to lymphocyte subpopulations and NK cell function, differences between the NLD and LD groups were not significant. There was a marginal decrease in HLA-DR+ lymphocytes in the NLD patients without a history of previous transfusion. CONCLUSIONS: There seems to be no major change in lymphocyte subpopulations and NK cell function 6 months after blood transfusion. Thus we cannot confirm our previous findings of a reduced number of CD20+ cells after blood transfusion.

A new vaginal antifungal agent--butoconazole nitrate.

The continuously increasing incidence of vulvovaginal candidiasis necessitated a search for novel therapeutic modalities. Butoconazole nitrate (BN) a new imidazole, has been singled out for clinical studies since, in experimental vaginal candidiasis, it proved more effective than either miconazole nitrate (MN) or clotrimazole. One hundred and thirty volunteers with vaginal candidiasis, verified by wet mount and positive fungal culture, were randomly assigned to receive daily, for 6 days, either 1% BN (44 patients), or 2% BN (45 patients) vaginal cream or 2% MN (41 patients) vaginal cream. The patients were comparable regarding age (85% were 18-39 years of age), gravidity and parity. Twenty-five per cent had a recent history of unsuccessfully treated fungal vaginitis. Eight days after completion of treatment, negative fungal cultures were found in 98% of the patients using 2% BN, in 91% of patients using 1% BN and in 83% using 2% MN. The recurrence rate of the disease was low; about 80% of patients using 1% and 2% BN and 68% of those using 2% MN were culture-negative 30 days after conclusion of treatment. Rapid relief of clinical symptoms was experienced by patients in all three treatment groups. No significant side effects of the treatment were observed in any of the treatment groups.

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.