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Hartwig MFS, Bulut M, Ravn-Eriksen J, Hansen LB, Bojesen RD, Klein MF, Jakobsen HL, Rasmussen M, Rud B, Eriksen JO, Eiholm S, Fiehn AMK, Quirke P, Gögenur I. Combined endoscopic and laparoscopic surgery (CELS) for early colon cancer in high-risk patients. Surg Endosc 2023; 37:8511-8521. [PMID: 37770605 PMCID: PMC10615913 DOI: 10.1007/s00464-023-10385-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/06/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Local excision of early colon cancers could be an option in selected patients with high risk of complications and no sign of lymph node metastasis (LNM). The primary aim was to assess feasibility in high-risk patients with early colon cancer treated with Combined Endoscopic and Laparoscopic Surgery (CELS). METHODS A non-randomized prospective feasibility study including 25 patients with Performance Status score ≥ 1 and/or American Society of Anesthesiologists score ≥ 3, and clinical Union of International Cancer Control stage-1 colon cancer suitable for CELS resection. The primary outcome was failure of CELS resection, defined as either: Incomplete resection (R1/R2), local recurrence within 3 months, complication related to CELS within 30 days (Clavien-Dindo grade ≥ 3), death within 30 days or death within 90 days due to complications to surgery. RESULTS Fifteen patients with clinical T1 (cT1) and ten with clinical T2 (cT2) colon cancer and without suspicion of metastases were included. Failure occurred in two patients due to incomplete resections. Histopathological examination classified seven patients as having pT1, nine as pT2, six as pT3 adenocarcinomas, and three as non-invasive tumors. In three patients, the surgical strategy was changed intraoperatively to conventional colectomy due to tumor location or size. Median length of stay was 1 day. Seven patients had completion colectomy performed due to histological high-risk factors. None had LNM. CONCLUSIONS In selected patients, CELS resection was feasible, and could spare some patients large bowel resection.
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Affiliation(s)
- Morten F S Hartwig
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark.
- Department of Surgery, Zealand University Hospital, Koege, Denmark.
| | - Mustafa Bulut
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ravn-Eriksen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lasse B Hansen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus D Bojesen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital Koege, Lykkebaekvej 1, 4600, Koege, Denmark
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital - Herlev & Gentofte Hospital, Herlev, Denmark
| | - Henrik L Jakobsen
- Department of Surgery, Copenhagen University Hospital - Herlev & Gentofte Hospital, Herlev, Denmark
| | - Morten Rasmussen
- Department of Surgery, Copenhagen University Hospital - Bispebjerg Hospital, Copenhagen, Denmark
| | - Bo Rud
- Department of Surgery, Copenhagen University Hospital - Hvidovre Hospital, Hvidovre, Denmark
| | - Jens-Ole Eriksen
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne Eiholm
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Anne-Marie K Fiehn
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Phil Quirke
- Pathology & Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jørgensen PB, Fenton TM, Mörbe UM, Riis LB, Jakobsen HL, Nielsen OH, Agace WW. Identification, isolation and analysis of human gut-associated lymphoid tissues. Nat Protoc 2021; 16:2051-2067. [PMID: 33619391 DOI: 10.1038/s41596-020-00482-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Gut-associated lymphoid tissues (GALTs) comprise key intestinal immune inductive sites, including the Peyer's patches of the small intestine and different types of isolated lymphoid follicle (ILF) found along the length of the gut. Our understanding of human GALT is limited due to a lack of protocols for their isolation. Here we describe a technique that, uniquely among intestinal cell isolation protocols, allows identification and isolation of all human GALT, as well as GALT-free intestinal lamina propria (LP). The technique involves the mechanical separation of intestinal mucosa from the submucosa, allowing the identification and isolation of submucosal ILF (SM-ILF), LP-embedded mucosal ILF (M-ILF) and LP free of contaminating lymphoid tissue. Individual SM-ILF, M-ILF and Peyer's patch follicles can be subsequently digested for downstream cellular and molecular characterization. The technique, which takes 4-10 h, will be useful for researchers interested in intestinal immune development and function in health and disease.
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Affiliation(s)
- Peter B Jørgensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Thomas M Fenton
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Urs M Mörbe
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Lene B Riis
- Department of Pathology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Henrik L Jakobsen
- Department of Gastroenterology, Surgical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Ole H Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - William W Agace
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark. .,Immunology Section, Lund University, Lund, Sweden.
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3
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Dolin TG, Mikkelsen M, Jakobsen HL, Nordentoft T, Pedersen TS, Vinther A, Zerahn B, Vistisen KK, Suetta C, Nielsen D, Johansen JS, Lund CM. Geriatric assessment and intervention in older vulnerable patients undergoing surgery for colorectal cancer: a protocol for a randomised controlled trial (GEPOC trial). BMC Geriatr 2021; 21:88. [PMID: 33516195 PMCID: PMC7847583 DOI: 10.1186/s12877-021-02045-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) increases with age. Older patients are a heterogeneous group ranging from fit to frail with various comorbidities. Frail older patients with CRC are at increased risk of negative outcomes and functional decline after cancer surgery compared to younger and fit older patients. Maintenance of independence after treatment is rarely investigated in clinical trials despite older patients value it as high as survival. Comprehensive geriatric assessment (CGA) is an evaluation of an older persons' medical, psychosocial, and functional capabilities to develop an overall plan for treatment and follow-up. The beneficial effect of CGA is well documented in the fields of medicine and orthopaedic surgery, but evidence is lacking in cancer surgery. We aim to investigate the effect of CGA on physical performance in older frail patients undergoing surgery for CRC. METHODS GEPOC is a single centre randomised controlled trial including older patients (≥65 years) undergoing surgical resection for primary CRC. Frail patients (≤14/17 points using the G8 screening tool) will be randomised 1:1 to geriatric intervention and exercise (n = 50) or standard of care along (n = 50) with their standard surgical procedure. Intervention includes preoperative CGA, perioperative geriatric in-ward review and postoperative follow-up. All patients in the intervention group will participate in a pre- and postoperative resistance exercise programme (twice/week, 2 + 12 weeks). Primary endpoint is change in 30-s chair stand test. Assessment of primary endpoint will be performed by physiotherapists blinded to patient allocation. Secondary endpoints: changes in health related quality of life, physical strength and capacity (handgrip strength, gait speed and 6 min walking test), patient perceived quality of recovery, complications to surgery, body composition (Dual-energy X-ray absorptiometry and bioelectric impedance), serum biomarkers, readmission, length of stay and survival. DISCUSSION This ongoing trial will provide valuable knowledge on whether preoperative CGA and postoperative geriatric follow-up and intervention including an exercise program can counteract physical decline and improve quality of life in frail CRC patients undergoing surgery. TRIAL REGISTRATION Prospectively registered at Clinicaltrials.gov NCT03719573 (October 2018).
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Affiliation(s)
- Troels G Dolin
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark.
- CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark.
| | - Marta Mikkelsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Henrik L Jakobsen
- Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Tyge Nordentoft
- Department of Surgery, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Trine S Pedersen
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Hospital Secretariat and Communications, Research, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Kirsten K Vistisen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Charlotte Suetta
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
- CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julia S Johansen
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilia M Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
- CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Fenton TM, Jørgensen PB, Niss K, Rubin SJS, Mörbe UM, Riis LB, Da Silva C, Plumb A, Vandamme J, Jakobsen HL, Brunak S, Habtezion A, Nielsen OH, Johansson-Lindbom B, Agace WW. Immune Profiling of Human Gut-Associated Lymphoid Tissue Identifies a Role for Isolated Lymphoid Follicles in Priming of Region-Specific Immunity. Immunity 2020; 52:557-570.e6. [PMID: 32160523 DOI: 10.1016/j.immuni.2020.02.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/09/2020] [Accepted: 02/13/2020] [Indexed: 12/19/2022]
Abstract
The intestine contains some of the most diverse and complex immune compartments in the body. Here we describe a method for isolating human gut-associated lymphoid tissues (GALTs) that allows unprecedented profiling of the adaptive immune system in submucosal and mucosal isolated lymphoid follicles (SM-ILFs and M-ILFs, respectively) as well as in GALT-free intestinal lamina propria (LP). SM-ILF and M-ILF showed distinct patterns of distribution along the length of the intestine, were linked to the systemic circulation through MAdCAM-1+ high endothelial venules and efferent lymphatics, and had immune profiles consistent with immune-inductive sites. IgA sequencing analysis indicated that human ILFs are sites where intestinal adaptive immune responses are initiated in an anatomically restricted manner. Our findings position ILFs as key inductive hubs for regional immunity in the human intestine, and the methods presented will allow future assessment of these compartments in health and disease.
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Affiliation(s)
- Thomas M Fenton
- Mucosal Immunology Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark.
| | - Peter B Jørgensen
- Mucosal Immunology Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark
| | - Kristoffer Niss
- Translational Disease Systems Biology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Samuel J S Rubin
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Urs M Mörbe
- Immunology Section, Lund University, BMC D14, 221-84 Lund, Sweden
| | - Lene B Riis
- Department of Pathology, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Clément Da Silva
- Immunology Section, Lund University, BMC D14, 221-84 Lund, Sweden
| | - Adam Plumb
- Immunological Memory Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark
| | - Julien Vandamme
- Mucosal Immunology Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark
| | - Henrik L Jakobsen
- Department of Gastroenterology, Surgical Section, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Søren Brunak
- Translational Disease Systems Biology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Aida Habtezion
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ole H Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Bengt Johansson-Lindbom
- Immunology Section, Lund University, BMC D14, 221-84 Lund, Sweden; Immunological Memory Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark
| | - William W Agace
- Mucosal Immunology Group, Department of Health Technology, Technical University of Denmark, Kemitorvet, 2800 Kgs. Lyngby, Denmark; Immunology Section, Lund University, BMC D14, 221-84 Lund, Sweden.
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5
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Dalager T, Jensen PT, Eriksen JR, Jakobsen HL, Mogensen O, Søgaard K. Surgeons' posture and muscle strain during laparoscopic and robotic surgery. Br J Surg 2020; 107:756-766. [DOI: 10.1002/bjs.11394] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/22/2019] [Accepted: 09/18/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS.
Methods
Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded.
Results
The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long-lasting periods of low-level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities.
Conclusion
Minimally invasive surgery requires long-term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture.
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Affiliation(s)
- T Dalager
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - P T Jensen
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J R Eriksen
- Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Denmark
| | - H L Jakobsen
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - O Mogensen
- Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Occupational and Environmental Medicine, Odense University Hospital, Odense, Denmark
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Vester-Andersen M, Waldau T, Wetterslev J, Møller MH, Rosenberg J, Jørgensen LN, Jakobsen JC, Møller AM, Gillesberg IE, Jakobsen HL, Hansen EG, Poulsen LM, Skovdal J, Søgaard EK, Bestle M, Vilandt J, Rosenberg I, Itenov TS, Pedersen J, Madsen MR, Maschmann C, Rasmussen M, Jessen C, Bugge L. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial). Br J Surg 2015; 102:619-29. [DOI: 10.1002/bjs.9749] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/06/2014] [Accepted: 11/14/2014] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery.
Methods
This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation (APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality.
Results
In total, 286 patients were included in the modified intention-to-treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310).
Conclusion
Postoperative intermediate care had no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. Registration number: NCT01209663 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M Vester-Andersen
- Department of Anaesthesiology and Intensive Care Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - T Waldau
- Department of Anaesthesiology and Intensive Care Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - J Wetterslev
- Department of Copenhagen Trial Unit, Centre for Clinical Intervention Research, Herlev, Denmark
| | - M H Møller
- Department of Intensive Care Medicine – 4131, Rigshospitalet, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - L N Jørgensen
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J C Jakobsen
- Department of Copenhagen Trial Unit, Centre for Clinical Intervention Research, Herlev, Denmark
| | - A M Møller
- Department of Anaesthesiology and Intensive Care Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | | | | | | | | | - M Bestle
- Hospital of North Zealand, Hillerød
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Pommergaard HC, Vilmann P, Jakobsen HL, Achiam MP. A clinical evaluation of endoscopically placed self-expanding metallic stents in patients with acute large bowel obstruction. Scand J Surg 2010; 98:143-7. [PMID: 19919918 DOI: 10.1177/145749690909800303] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Self-expanding metallic stents (SEMS) have since 1991 established themselves as an option in the treatment of large bowel obstruction. The aim of this study was to evaluate the use of SEMS in management of acute colorectal obstructions at a Danish Surgical Gastroenterology center. MATERIAL AND METHODS Retrospective review of charts from all patients who, in the period Marts 2002 to December 2007 underwent insertion of a SEMS for an acute large bowel obstruction. RESULTS Of 45 patients included, SEMS was intended as a bridge to surgery in 20 patients and as palliation in 25 patients. For malignant etiology, the SEMS procedure was a technical and clinical success in 97.4% of the cases. Complications occurred in 21%, mortality rate 2,6%. For benign etiology, the SEMS procedure was a technical success in 85.7%, and a clinical success in 71.4%. Complications occurred in 71.4% of the benign cases with a mortality rate of 28,6%. CONCLUSIONS Placement of SEMS for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. However results for benign obstructions are questionable and more research is needed to determine the role of SEMS.
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Affiliation(s)
- H C Pommergaard
- Department of Surgical Gastroenterology Z, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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8
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Bisgaard T, Jakobsen HL, Jacobsen B, Olsen SD, Rosenberg J. Randomized clinical trial comparing radially expanding trocars with conventional cutting trocars for the effects on pain after laparoscopic cholecystectomy. Surg Endosc 2007; 21:2012-6. [PMID: 17705082 DOI: 10.1007/s00464-007-9517-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 05/08/2007] [Accepted: 06/01/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Trocar incisions are important sources of pain the first days after laparoscopic cholecystectomy. Radially expanding trocars may cause less pain than conventional cutting trocars. METHODS In a patient- and observer-blinded trial, 80 patients were randomized to undergo laparoscopic cholecystectomy using either radially expanding trocars (radial group) or conventional cutting trocars (cutting group). Two 10-mm and two 5-mm trocars were used in both treatment groups. All the patients received standardized anesthetic and analgesic treatment. The primary outcome was incisional pain. Pain was registered during mobilization using a visual analog scale (VAS) and a verbal rating scale (VRS) before and 6 h after the operation, and at postoperative days 1 and 2. The needs for a fascial incision to retract the gallbladder, active surgical hemostasis, and supplementary requirements of opioids during the hospital stay were registered. In addition, 2 days after the operation, the incidence and severity of suggilations at the trocar incisions were measured. RESULTS Data from 77 patients were available for statistical analysis. In the radial group, 23 patients needed fascial incision for gallbladder retraction compared with 11 patients in the cutting group (p = 0.006). No significant intergroup differences in VAS or VRS pain scores or any other variable were found. CONCLUSIONS The use of radially expanding trocars has no effect on incisional pain after laparoscopic cholecystectomy.
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Affiliation(s)
- T Bisgaard
- Department of Surgical Gastroenterology, University of Copenhagen, Gentofte Hospital, 2900, Gentofte, Denmark.
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9
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Abstract
Early graft occlusion after coronary artery bypass grafting may have deleterious consequences. We routinely use transit-time flowmetry after termination of cardiopulmonary bypass, and we report five cases of early graft failure detected by the flowmeter. Electrocardiographic (ECG) changes were seen in only one of these five cases, and none of the patients had low cardiac output or other signs of graft failure at the end of the operation. The cause of graft failure was tagging in one case, rotation of internal mammary artery grafts in two and kinking of vein grafts in two cases. All errors were corrected, and control flowmetry showed normal flow rates after correction. Flowmetry takes less than 10 min, even with multiple bypass grafts. Based on our results, we advocate routine quality control with flowmetry after termination of cardiopulmonary bypass, since ECG changes are insufficient as checks of flow in bypass grafts.
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Affiliation(s)
- H L Jakobsen
- Department of Cardiothoracic Surgery, Gentofte Hospital, University of Copenhagen, Denmark
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10
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Abstract
OBJECTIVES To determine the value of PTFE grafts with a distal vein cuff as a conduit for below-knee (BK) popliteal and distal bypass in the absence of autologous vein. DESIGN Retrospective study. MATERIALS AND METHODS Forty below BK popliteal and distal bypass procedures in 39 patients with PTFE and distal vein cuff (Miller cuff n = 31, Wolfe cuff and adjuvant arteriovenous fistula n = 9). Nineteen primary and 21 secondary reconstruction procedures. RESULTS The primary patency rate was 62.5% at 1 year falling to 50% at 2 years. The secondary patency rates were very similar owing to poor outcome of thrombectomy. Ten cases (25%) resulted in major amputation postoperatively. There was a tendency towards better outcome for primary procedures compared to secondary/redo procedures. CONCLUSIONS BK popliteal and distal bypass with PTFE and distal vein cuff is a worthwhile procedure in the absence of autologous vein. The value of thrombectomy following thrombosis of a secondary bypass procedure with PTFE and distal vein cuff is questionable.
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Affiliation(s)
- H L Jakobsen
- Vascular Section, Gentofte University Hospital, Denmark
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11
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Jakobsen HL, Bagi P, Jørgensen JB, Colstrup H. [Waiting lists for men with benign urinary disorders]. Ugeskr Laeger 1998; 160:300-4. [PMID: 9454407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper reflects the problems in having a large non-specific waiting-list. One hundred and twenty-eight patients were on a waiting-list under the main diagnosis of prostatism. This diagnosis revealed seven patients with cancer in the urinary tract system. Only two-thirds of the patients on the waiting-list were interested in further examination and treatment. This paper emphasizes the need for a more specific referral, when dealing with symptoms from the lower urinary tract system.
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Affiliation(s)
- H L Jakobsen
- Amtssygehuset i Gentofte, urologisk-karkirurgisk afdeling H
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Jakobsen HL, Henriksen FW. [Necrotizing pancreatitis]. Ugeskr Laeger 1995; 157:5534-5537. [PMID: 7571095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Acute pancreatitis is in the majority of patients a mild, self-limiting illness. Five to fifteen percent of the patients develop acute necrotizing pancreatitis, a severe illness with a high morbidity and mortality. Secondary infection of the pancreatic necrosis (infected pancreatic necrosis) is the main cause of death. Pancreatic necrosis is identified with a high accuracy by contrast-enhanced computed tomography. The differentiation between sterile and infected necrosis requires demonstration of bacteria or fungi isolated from the necrosis. Surgical treatment of a sterile necrosis remains controversial, but there is a tendency towards conservative non-operative treatment. Infected pancreatic necrosis is regarded as an absolute indication for surgery, untreated the mortality is approximately 100%. The aim of modern treatment is to remove the pancreatic necrosis continuously. This has successfully been done by the open packing method, with or without subsequent drainage. At present no randomized trials comparing the different treatment modalities are available. The question of prophylactic antibiotics still remains unanswered. For the present imipenem 0,5 g x 3 is recommended.
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Affiliation(s)
- H L Jakobsen
- Kirurgisk-gastroenterologisk afdeling D., Amtssygehuset i Gentofte
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