Survival and incidence of colorectal cancer in patients with ulcerative colitis in Funen county diagnosed between 1973 and 1993.

BACKGROUND: The aim of the study was to determine the death rate and the risk of developing colorectal cancer in patients with ulcerative colitis in Funen County. METHODS: The medical records of 801 patients with ulcerative colitis diagnosed in 1973-93 in Funen County were scrutinized with regard to colectomy, survival, and colorectal cancer, and in 1998 a follow-up was carried out. RESULTS: The patients were managed at nine different hospitals: one university hospital, one central hospital, and seven smaller hospitals. The mean age at diagnosis was 41 years, and the mean duration of disease was 10.11 years. Sixty-one per cent of the patients were classified as having proctosigmoiditis, 21% as having left-sided colitis, and 18% as having pancolitis. In 127 patients who underwent proctocolectomy during the study period lethal complications occurred in 8 cases: 5 of 110 in Odense University hospital and 3 of 17 in the other hospitals. One hundred and twenty patients in the cohort died during the period of observation, nine of them of colitis-related causes. There was a slightly increased risk of early death in the cohort after 15 years of disease. Six colorectal cancers were found, whereas four were expected, giving a standard incidence ratio of 1.665. The cumulative cancer risk after 20 years' disease duration was 5.3% in the observed group, contrasting with an expected rate of 0.49%, and 10.1% after 25 years. CONCLUSION: In this cohort of ulcerative colitis patients the mortality and the risk of developing colorectal cancer were slightly higher than expected compared with the background population.

[Aminoglycoside treatment I. Administration of gentamicin once versus three times daily]. / Aminoglykosidbehandling I. Gentamicinbehandling én gang versus tre gange daglig.

Gentamicin is the most commonly used aminoglycoside in Danish hospitals. The aim of this study was to compare two dosage regimens, thrice-a-day (TID) and once-a-day (OD) with regard to efficacy, safety and tissue toxicity. Twenty-three patients were allocated to TID and 26 were allocated to OD gentamicin. Data from patients treated for more than 72 hours were evaluated. Efficacy was assessed by the rate at which body temperature fell to normal. Renal toxicity was judged by an increase in serum creatinine of more than 50 mumol/l and inner ear toxicity was clinically estimated daily during treatment, followed up by audiometry if positive signs occurred. Serum gentamicin was determined daily to estimate the size of next dose. A low frequency of dose adjustments was considered to reflect safety, as well as the absence of renal and inner ear affection. Results showed no significant differences between the two groups regarding efficacy, safety or tissue toxicity. Renal toxicity developed in two patients on TID regime and in one patient on OD regime. No inner ear toxicity was seen. The renal toxicity appeared unpredictably, both early and late in the treatment period and preceded by low or high values serum gentamicin. It is recommended that gentamicin be administered OD for reasons of economy and convenience and that kidney function be monitored daily throughout the treatment period.

[Aminoglycoside treatment II: Dosage regimes at the departments of internal medicine in Denmark]. / Aminoglykosidbehandling II. Dosisregimer på intern-medicinske afdelinger i Danmark.

The aim of this study was to get a general view of the habitual practice of the usage of aminoglycosides in Danish medical departments, regarding choice of drug, dosage regimen and monitoring of drug-related toxicity, as this antimicrobial agent is commonly used in Danish hospitals against severe infections in spite of the potential for nephro- and ototoxicity. The survey, taking place in 1991 and in 1994, showed that gentamicin and netfilmicin were preferred as first choice with an equal frequency in university and county hospital department, whereas in departments in small hospitals gentamicin was preferred twice as often. From 1991 to 1994 the dosage regimen most commonly used had altered from thrice-a-day to once-a-day. Monitoring of serum levels of the drug was performed on all treated patients in fifty-two of the seventy-nine departments questioned. Most of the departments also monitored the kidney function.

[Eosinophilic gastroenteritis]. / Eosinofil gastroenteritis.

Two case stories of eosinophilic gastroenteritis are described. Both patients presented with chronic diarrhoea and weight loss. The first patient had eosinophilic infiltration predominantly in the mucosal layer of the intestine, and had in addition loss of protein in the stool. The other patient had predominantly subserosal eosinophilic infiltration and presented with eosinophilic ascites. Both patients were treated with prednisolone and responded immediately to therapy.

[Botulism on the Faeroe Islands]. / Botulisme på Faerøerne.

Four outbreaks of botulism in the Faroe Islands in 1979, 1988 og 1989 are reported. Seven patients were involved and one died. All persons had eaten dried mutton. In one case, Clostidium botulinum type was not determined, while in other outbreaks one patient had type B botulism and two type E botulism.

Effect of alfentanil anaesthesia on the adrenocortical and hyperglycaemic response to abdominal surgery.

Plasma concentrations of cortisol and glucose were measured from before to 9 h after skin incision in 24 patients undergoing abdominal hysterectomy. The patients were randomly allocated to receive either high-dose alfentanil anaesthesia (150 micrograms kg-1 initially, followed by continuous infusion at a rate of 3 micrograms kg-1 min-1) or neurolept anaesthesia (droperidol 0.25 mg kg-1 plus fentanyl 5 micrograms kg-1 initially, followed by intermittent incremental doses of fentanyl 50 micrograms). The intraoperative and initial postoperative increases in plasma cortisol and glucose concentrations were inhibited (P less than 0.05) by alfentanil but, later in the postoperative period, both groups showed identical increases in cortisol and glucose concentrations. Mean arterial pressure and heart rate were more stable in the alfentanil group. The concept of "stress-free" anaesthesia during high-dose opiate administration seems to be valid during operation and for the initial 1-3 h into the postoperative period.

The modifying effect of spinal anaesthesia on intra- and postoperative adrenocortical and hyperglycaemic response to surgery.

Plasma cortisol and glucose were measured in 24 patients undergoing abdominal hysterectomy during spinal anaesthesia with 0.5% hyperbaric tetracaine or neurolept anaesthesia. The sensory level of analgesia to pinprick extended to at least T4 before skin incision in the spinal group. The mean sensory analgesic level regressed almost linearly, reaching the fourth lumbar segment 4 h after incision. Plasma cortisol and glucose measurements from before to 9 h after skin incision showed significant increases in both parameters during and after surgery. Plasma cortisol and glucose levels were significantly lower during and immediately after surgery in the spinal group, but later postoperatively the mean levels were similar in the two groups. The increase in plasma cortisol 1 h after skin incision in the spinal group correlated to the segmental level of analgesia at that time (r = 0.77, P less than 0.01) and a similar correlation was found with regard to plasma glucose changes (r = 0.60, P less than 0.05). The regression lines showed that maintenance of a sensory analgesic level about the fourth thoracic segment prevented the adrenocortical and hyperglycaemic response to surgery. These findings are in accordance with the anatomical assumption that the upper segmental level of visceral afferent input to the spinal cord is about the fourth thoracic segment. Our results further demonstrate that the inhibitory effect of spinal anaesthesia on the stress response to surgery is transient, and correlates to the regression of sensory analgesia.