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ABSTRACT: Flatus is natural and an invariable consequence of digestion, however at times it creates problems of social character due to sound and odour. This problem may be more significant on commercial airplanes where many people are seated in limited space and where changes in volume of intestinal gases, due to altered cabin pressure, increase the amount of potential flatus. Holding back flatus on an airplane may cause significant discomfort and physical symptoms, whereas releasing flatus potentially presents social complications. To avoid this problem we humbly propose that active charcoal should be embedded in the seat cushion, since this material is able to neutralise the odour. Moreover active charcoal may be used in trousers and blankets to emphasise this effect. Other less practical or politically correct solutions to overcome this problem may be to restrict access of flatus-prone persons from airplanes, by using a methane breath test or to alter the fibre content of airline meals in order to reduce its flatulent potential. We conclude that the use of active charcoal on airlines may improve flight comfort for all passengers.
The New Zealand medical journal 01/2013; 126(1369):68-74.
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ABSTRACT: The are currently a number of unsolved clinical questions in colorectal surgery with new surgical principles being introduced without proper scientific high-level evidence. These include complete mesocolic excision with central ligation for colonic cancer, extralevator abdominoperineal excision for low rectal cancer, robotic surgery for various colorectal procedures, laparoscopic lavage without resection for Hinchey Stage III perforated sigmoid diverticulitis, and the use of the single port technique for laparoscopic surgery. Before general implementation the new modalities should ideally be evalueted in randomized studies and meta-analyses. Many randomized studies, however, cannot give the final answer to the research question because they are underpowered and it is therefore important to perform well-designed studies that are large enough to provide the final answer. A way forward could therefore be to form multicenter and even multinational research groups in order to ensure accrual of sufficient sample sizes.
Colorectal Disease 11/2011; 14(3):266-9. · 2.93 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the incidence of per- and postoperative complications of low anterior resection and Hartmann's operation (HO) for rectal cancer. The study was performed in a department with a high frequency of HO.
Patients who had undergone low anterior resection (LA) or HO for rectal cancer at the Department of Surgery, Gentofte Hospital, between 1 January 2001 and 31 December 2007.
A total of 187 patients were operated using LA or HO technique during this period. LA was performed in 103 patients and HO in 84 patients. ASA-scores were significantly higher for patients who underwent HO (p = 0.0066). There was no significant difference in complication rates between the two groups (p = 0.385). The 30-day mortality rate was 3.2% (n = 6) for all patients, and it was not significantly different between the two groups (HO 3.6% (n = 3) and LA= 2.9% (n = 3), p = 1). One ASA III patient who underwent LA died from anastomotic leakage whereas no ASA III patients operated with HO died. There was no significant difference between the groups for any other per- and postoperative complication.
In this material, HO rather than LA seems to be the safer choice for high risk rectal cancer patients with ASA > 3 in terms of mortality rate compared with the national index.
Ugeskrift for laeger 09/2010; 172(39):2675-8.
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ABSTRACT: Patients with disseminated colorectal cancer have a poor prognosis. Preliminary studies have shown encouraging results from vaccines based on dendritic cells. The aim of this phase II study was to evaluate the effect of treating patients with advanced colorectal cancer with a cancer vaccine based on dendritic cells pulsed with an allogenic tumor cell lysate. Twenty patients with advanced colorectal cancer were consecutively enrolled. Dendritic cells (DC) were generated from autologous peripheral blood mononuclear cells and pulsed with allogenic tumor cell lysate containing high levels of cancer-testis antigens. Vaccines were biweekly administered intradermally with a total of 10 vaccines per patient. CT scans were performed and responses were graded according to the RECIST criteria. Quality of life was monitored with the SF-36 questionnaire. Toxicity and adverse events were graded according to the National Cancer Institute's common Toxicity Criteria. Four patients were graded with stable disease. Two remained stable throughout the entire study period. Analysis of changes in the patients' quality of life revealed stability in the subgroups: 'physical function' (p=0.872), 'physical role limitation' (p=0.965), 'bodily pain' (p=0.079), 'social function' (p=0.649), 'emotional role limitation' (p=0.252) and 'mental health' (p=0.626). The median survival from inclusion was 5.3 months (range 0.2-29.2 months) with one patient still being alive almost 30 months after inclusion in the trial. Treatment with this DC-based cancer vaccine was safe and non-toxic. Stable disease was found in 24% (4/17) of the patients. The quality of life remained for most categories high and stable throughout the study period.
Oncology Reports 01/2009; 20(6):1305-11. · 1.84 Impact Factor
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Anders Fischer
Ugeskrift for laeger 10/2007; 169(38):3177.
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ABSTRACT: Previous studies have shown an association between surgical volume and a decreased mortality rate for departments as a whole as well as for individual surgeons. The background for this study was to investigate whether it would be beneficial to centralize gastric surgery, not only in fewer departments but also in fewer hands in the department.
The study was based on the patient records of the 93 patients operated between 1 January 2000 and 1 September 2005. The surgeons were divided into two groups based on whether they had performed more than 15 or less than 5 operations during the period.
Of the 93 operations, 3 surgeons performed 80 and 7 surgeons performed the remaining 13 operations. The mortality was significantly increased in patients operated by surgeons with a low operation volume, p = 0.0004. The 12 acute operations were performed as often by a surgeon with low operation volume as by a surgeon with high operation volume. Again, mortality increased when the operation was performed by a surgeon with low operation volume, p = 0.015.
The results argue for a centralization of gastric resections on a few surgeons and for an organisation of acute surgery so that these procedures are performed by only a few experienced surgeons.
Ugeskrift for laeger 06/2007; 169(21):2009-12.
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ABSTRACT: Parastomal hernias occur frequently after placement of a permanent colostomy. Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia. We studied the safety and prophylactic effect of placing a newly designed polypropylene mesh in an onlay position at the primary operation.
This was a prospective study that included 25 patients scheduled for elective colorectal surgery. Risk factors for development of parastomal hernia were recorded before surgery. A prepared lasercut polypropylene mesh with six "arms" was placed in an onlay position. Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon. Abdominal ultrasound was performed at 6 and 12 months follow-up. Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma.
The median follow-up time was 12 (range, 2-26) months. One patient died eight days after surgery. Of the 24 patients included, none had infections or immediate complications after surgery. Two patients had minor complications necessitating a local revision of one of the mesh arms. No other long-term complication was found. Two patients had signs of parastomal hernia at 6 and 12 months follow-up, respectively.
Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence.
Diseases of the Colon & Rectum 09/2006; 49(8):1131-5. · 3.13 Impact Factor
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ABSTRACT: Operation for paraoesophageal hernia may be associated with severe complications, especially when performed as an open technique. Furthermore, it is not settled whether the procedure should be performed in combination with an antireflux procedure. Fast-track rehabilitation programs in other operations have been associated with shortened hospital stay and reduced complications compared with conventional care programs. The aim of the present study was to combine a simplified surgical technique with a fast-track rehabilitation program for repair of giant paraoesophageal hernia.
During a 2-year period, 21 patients underwent laparoscopic paraoesophageal hernia repair with a fast-track rehabilitation program. We did not use an antireflux procedure or repaired the enlarged hiatus in any of the patients. All patients had the hernia sac dissected and a gastropexy to the anterior abdominal wall.
Median operation time was 75 min (range 65-120), and the median postoperative hospital stay was 2 days (1-20), where 10 patients stayed for only 1 day. Two patients received postoperative blood transfusions, and the same 2 patients also developed postoperative pneumonia treated with penicillin. Before operation, 4 patients were treated with proton pump inhibitors for reflux symptoms, but after operation, only 1 patient continued treatment with omeprazol 20 mg daily. At barium x-ray follow-up after 3 months, 3 patients had a partial recurrence of a paraoesophageal hernia, but none of them had any symptoms and therefore did not undergo further treatment.
Using a fast-track rehabilitation program and a simplified laparoscopic surgical technique, repair of giant paraoesophageal hernias can be performed with a short hospital stay and minimal complications.
Langenbeck s Archives of Surgery 03/2006; 391(1):38-42. · 1.81 Impact Factor
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ABSTRACT: Around 2,300 new cases of colon cancer are diagnosed in Denmark every year. Surgical treatment follows the standard criteria, including removal of as many lymph nodes as possible to ensure correct classification of the disease. For staging, the sentinel node principal may also be advantageous, but this is not yet routine in colon cancer. Patients with Dukes' C disease routinely receive adjuvant chemotherapy. For patients with Dukes' B disease, chemotherapy is not routine but may be given in selected cases.
Ugeskrift for laeger 12/2005; 167(45):4258-60.
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ABSTRACT: In spite of improved surgical principles in colorectal surgery, patients undergoing this operation still suffer from long-term postoperative complications. Many patients have permanent stomas, and up to 60% have problems related to their stomas, the most frequent of these being parastomal hernia. In this context, the use of primary prophylaxis with mesh insertion is encouraging. Before the introduction of total mesorectal excision (TME), there was a very high rate of bladder problems and sexual dysfunction with impotence and retrograde ejaculation. The rate has been reduced dramatically since the introduction of TME, but up to 5% of patients still suffer from permanent bladder dysfunction and complete impotence.
Ugeskrift for laeger 12/2005; 167(45):4272-5.
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Ugeskrift for laeger 02/2005; 167(3):286-9.
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Ugeskrift for laeger 12/2004; 166(48):4357-9.
