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Biomedical subjects

C Fenger

Publications and source records attributed to C Fenger.

At least 19 recordsLinked to original sources
PubMed1992

Can Hemoccult-II replace colonoscopy in surveillance after radical surgery for colorectal cancer and after polypectomy?

Surveillance after colorectal carcinoma and adenoma includes colonoscopy, which is a demanding procedure for the patient, doctor, and society. Therefore, it was investigated whether a simple fecal occult blood test could replace colonoscopy. Hemoccult-II (H-II) was performed before 1,244 colonoscopies in patients with previous cancer and before 328 colonoscopies in an adenoma surveillance program. The H-II test was positive in 3 of 9 patients with local recurrence, in 2 of 13 with metachronous cancer, and in 31 of 186 with adenomas. The test was positive more often in patients with large and multiple adenomas, sigmoid adenomas, and adenomas with villous elements and moderate-to-severe dysplasia, but the sensitivity did not reach more than 25 to 40 percent. It was concluded that markers more sensitive than H-II are needed to detect metachronous cancers and new adenomas. In the meantime, colonoscopy has to be used with intervals of several years, but not for detection of local recurrent cancer, which in most cases may be found by simpler means.

Chi-Square Distribution↗
PubMed1992

Echo pattern of lymph nodes in colorectal cancer: an in vitro study.

Surgical specimens from 75 patients with colorectal cancer were examined within 15 min of removal with a 7.5 MHz linear-array transducer. The echo pattern of 139 lymph nodes was analysed to evaluate previous criteria of malignancy and to establish other possible criteria, which could be tested in vivo. The pathologist examined each node without knowledge of the sonographic finding. Malignant nodes were larger than benign nodes. Of 21 nodes less than 5 mm in diameter, 20 were benign. Round nodes were malignant more often (45/78) than ovoid nodes (6/61). A homogeneous echo pattern was associated with malignancy in 39 of 82 nodes in contrast to 12 of 57 with a heterogeneous pattern. Thirty-one nodes were ovoid as well as heterogeneous and all of these were benign. A hyperechoic centre was found in 14 nodes of which two were malignant. The highest predictive value for malignancy (59%) was obtained by combining the discriminative properties of shape, homogeneity and echogenicity.

Colorectal Neoplasms↗
PubMed1992

Observer homogeneity in the histologic diagnosis of Helicobacter pylori. Latent class analysis, kappa coefficient, and repeat frequency.

Four pathologists independently examined 82 antral mucosal biopsy specimens for the presence of Helicobacter pylori and indicated whether their assessments were certain. The pathologists made a positive diagnosis in from 56% to 84% of the specimens (significant heterogeneity, p < 0.01). The frequency of uncertain diagnoses was from 4% to 20% (p < 0.01). Uncertain statements occurred more frequently among negative than among positive diagnoses. For the six pairs of observers the kappa coefficients were between 0.39 and 0.82. By a latent class analysis measures of diagnostic accuracy were calculated comparing the observers' assessments with an estimated consensus diagnosis. The predictive values of a positive diagnosis ranged from 0.70 to 1.00. By calculation of repeat frequencies--that is, the probability that an observer's statement was confirmed by another observer--it became evident that uncertain statements were less frequently (61%) confirmed than were certain ones (85%). It is concluded that observer homogeneity is only moderate with regard to the histologic diagnosis of H. pylori, which should be considered both in daily clinical routine and in scientific studies. Disagreement between observers was associated with negative diagnoses, presumably because the pathologists felt more uncertain in these cases.

Adult↗
PubMed1992

Causes of death during the first 5 years of a randomized trial of mass screening for colorectal cancer with fecal occult blood test.

The main purpose of population screening for colorectal cancer is to reduce mortality from the disease. The criteria of death from colorectal cancer are defined in the present randomized trial of 61,938 persons between 45 and 74 years old, and the need for an impartial death review committee was demonstrated. Causes of death within the first 5 years are described within subgroups of the test group and compared with those in the control group. Death rates were higher among non-responders to screening than among controls and among those in whom Hemoccult-II had been performed at least once. Persons with negative Hemoccult-II had a lower death rate than controls. The overall autopsy rate was 32%. Lethal complications from treatment of colorectal neoplasia were evaluated per se. Death from colorectal cancer occurred in 74 persons in the total screening group and in 91 among controls. Sources of bias are discussed. A method of evaluating possible benefit to those being screened is suggested. Final results cannot be expected before 1996.

Aged↗
PubMed1992

Interval cancers in screening with fecal occult blood test for colorectal cancer.

Interval cancers, which are cancers diagnosed in spite of one or more negative screening tests, were studied in a randomized population with Hemoccult-II for colorectal cancer in 61,938 persons between 45 and 74 years old. Three biannual screenings were performed from 1985 to 1991, and 52% of all the cancers detected after doing at least one Hemoccult-II test were interval cancers (81 persons). These were more advanced than cancers diagnosed after a positive Hemoccult-II test, of larger size, less frequently of Dukes stage A, more often invading neighboring organs, and less often resectable for cure. They were located in the rectum more often than cancers diagnosed by screening and cancers in controls. Otherwise, interval cancers did not differ from cancers in controls or cancers in non-responders, and all characteristics suggested that no delay in diagnosis resulted from one or more negative Hemoccult-II tests, compared with controls. However, even if screening with Hemoccult-II demonstrates a reduction in mortality from colorectal cancer, the present high number of interval cancers makes it necessary to look for other methods of screening populations for colorectal cancer.

Aged↗
PubMed1991

[Curative local excision of colorectal cancer. A prospective study].

The importance of local treatment for early colorectal cancer is apparent because of increasing endoscopical activity for diagnostic purposes and screening. Curative local treatment was attempted in 63 patients with polypoid, mobile tumours thought to be within the bowel wall and without palpable lymph nodes in the perirectal tissue. Tumours more than 3 cm in diameter were excluded, unless they were pedunculated or were believed to be adenomas with carcinoma. Removal was effected by polypectomy, piecemeal removal, peranal excision, posterior rectotomy or colotomy. Complications were few, and hospitalization was shorter than after conventional surgery, but one patient died from treatment. More extensive surgery followed in 12 patients, in whom cancer remained in the resection margin or where this could not be excluded. However, seven of the 12 patients had no residual cancer tissue. Survival without recurrence was longer in patients with tumours below 3 cm in diameter. Recurrence was seen in nine patients, but not in those with cancer limited to head and the stalk of pedunculated tumours and not with cancer limited to the luminal part of submucosa, regardless of shape of tumour. Adenoma in continuity with cancer did not influence survival significantly, but synchronous adenomas in other parts tended to increase recurrence-free survival. Local treatment is satisfactory in most patient with cancer within pedunculated polyps and in some with cancer in sessile polypopid tumours. Criteria of selection are not optimal and the use of endoluminal ultrasound examinations must be evaluated in prospective trials. At present, conventional surgery should be used when cancer in the resection margin cannot be excluded, when cancer is present in the deeper layers of muscularis propria and in patients with poorly differentiated cancers.

Adult↗
PubMed1991

[Colonoscopy after radical surgery for colorectal cancer. A 10-year prospective study of 309 patients].

Experience from ten year colonoscopic follow-up in patients after radical surgery for colorectal cancer is presented. In all, 309 patients below 76 years were included from 1978 to 1983. All had preoperative proctoscopy and barium enema. Colonoscopy was performed perioperatively, every six months the first three years, four and five years, seven to eight years and ten years after surgery. A minority had double-contrast barium enemas. Synchronous adenomas were removed during surgery and at perioperative colonoscopy and these patients had the same risk of metachronous cancer as those without synchronous adenomas. Five patients with six metachronous cancers, all had new curative surgery. Patients with synchronous adenomas had a higher risk of metachronous adenomas, but had a better prognosis than those without synchronous adenomas. Colonoscopically demonstrated intraluminal local recurrence in the colon could not be treated with new radical surgery in contrast to four out of eight intraluminal recurrences in the rectum. Most local recurrences were extraluminal and were diagnosed by other means.

Adenoma↗
PubMed1991

Melanocytes in the anal canal epithelium.

We studied the presence of melanocytes in the various epithelial zones of the anal canal, using a recently introduced melanocyte-specific antibody (HMB-45) together with antibody to S-100 protein. In normal and canals and in haemorrhoids, melanocytes, defined as intraepithelial HMB-45/S-100 positive cells, were frequently demonstrated in the anal squamous zone, only sporadically in the anal transitional zone, and not at all in the colorectal zone. In the epithelium surrounding, but clearly separated from, resected primary anal malignant melanomas, increased numbers of benign melanocytes were demonstrated in the squamous zone and transitional zone, but also in the colorectal zone. We interpret this finding as a tumour-induced proliferation of benign melanocytes normally present, but in very small numbers or in some way 'masked', in the epithelium of the upper anal canal. The demonstration of melanocytes in all three zones of the anal canal substantially supports the observation that malignant melanoma of the anal canal may originate not only below but also above the dentate line.

Anal Canal↗
PubMed1991

Anal neoplasia and its precursors: facts and controversies.

The normal anal mucosa shows a complex histology, and a large variety of tumors and lesions with more or less malignant potential may arise in this region. Several of these seem to be related to venereal diseases, homosexual behavior, and anal intercourse, and to immunosuppression. Human papilloma virus (HPV) has been identified in many cases, but the relation to the histological picture is not constant and the significance is unclear. However, these observations have helped us to identify risk groups. Histological classification is often difficult and it is likely that the reproducibility is limited. This may, in part, explain different observations with regard to frequency and biological behavior. A reliable diagnosis still largely depends on exact clinical information on location and appearance, detailed knowledge of the normal histology, and careful handling of the specimen. The revised World Health Organization (WHO) classification represents an improvement, but more variants are still identified and a classification based on conventional histology alone seems in many cases unsatisfactory. Immunohistochemistry and hybridization and other techniques hopefully will provide us with improved typing of these lesions.

Adenocarcinoma↗
PubMed1979

Histochemical characteristics of mucins in the small intestine. A comparative study of normal mucosa, benign epithelial tumours and carcinoma.

The histochemical properties of the mucins in seven benign epithelial tumours and 15 carcinomas distributed along the duodenum, jejunum and ileum were investigated and compared with normal controls. This study reveals that (a) goblet cells in normal small intestine contain neutral and sialomucins but no sulphated material; (b) the proportion of the different types of mucins in the goblet cells vary along the crypts and villi with an increasing amount of sialomucins towards the villus top; (c) mucin composition also changes from duodenum to ileum particularly in the proportions of sialic acid types and in the presence of traces of sulphomucins in the ileal mucosa close to the ileo-caecal valve, suggesting a gradual transition through the small intestine to the colon; (d) benign tumours show the same mucin pattern as normal mucosa; (e) the adjacent to carcinoma shows increasing amounts of sialomucins and sulphomucins; (f) carcinomas present a variety of mucin patterns, and thus the study of mucins seems to be of no value in differentiating tumours of the small intestine from those elsewhere in the gastrointestinal tract. A working hypothesis based on the Unitary Theory of the origin of the intestinal epithelial cells is proposed to explain the variations in glycoprotein synthesis with cell differentiation and carcinogenes.

Adult↗
PubMed1979

The anal transitional zone. Location and extent.

The location and extent of the anal transitional zone (ATZ) were investigated in the age group typical for anal canal carcinomas. The methods used were macroscopic determination after whole-mount staining with Alcian-dyes as well as conventional histological technique. The results show that the epithelial variants may be found over a larger area than previously reported, namely from 6 mm below to 20 mm above the dentate line. Variations in location and extent of the ATZ are described, as well as the frequent finding of mature squamous epithelium high in the anal canal. The significance of the findings in relation to the special types of anal canal carcinomas is discussed, and on the basis of the macroscopic definition of the canal, as well as the histological observations in this study, it is proposed that anal canal carcinomas should be defined as tumours partly or totally located within a distance of 2 cm above the dentate line.

Adenocarcinoma↗
PubMed1978

Gastric ulcer in old age.

One hundred and eleven (16%) of 701 patients with gastric ulcers, admitted to Kommunehospitalet, Copenhagen, from 1955 to 1964, were 70 years of age of older. Of those elderly patients, 43 were treated surgically, 68 non-surgically. The incidences of hemorrhage and extragastric diseases were significantly greater in older patients, whereas the incidence of pain, site of pain, ulcer size, and location, incidence of combined ulcers and gastric retention did not differ from those observed in younger patients. The duration of symptoms was shorter in the aged, though the difference was not significant. Prognosis was less favourable in the aged, largely due to a higher incidence of hemorrhage (47%) and of accessory diseases (47%). The mortality in elderly patients suffering from hemorrhage and accessory diseases was 64% during hospitalization, but only 4% in patients without accessory diseases. Follow-up and autopsy studies of discharged patients revealed that ulcers healed in only half of the non-surgical patients and that surgery was ultimately necessary in 50% of these. It was concluded that the factors which prescribed surgical treatment in elderly patients with gastric ulcers did not differ considerably from those in younger patients. The risk was greater, but this was also true in non-surgical treatment. Close cooperation between surgeon and physician was essential, both pre- and postoperatively, since accessory diseases were very significant for the outcome.

Age Factors↗
PubMed1978

The anal transitional zone. A method for macroscopic demonstration.

The anal canal extends from the upper to the lower border of the internal sphincter. The canal can histologically be divided into three zones according to the epithelial lining, being of colo-rectal type in the upper part and squamous in the lower part, while the middle part, where the epithelium varies, is called the anal transitional zone (ATZ). This zone can be demonstrated macroscopically using whole mount staining with Alcian dyes, which reveal it as light green or blue, contrasting to the dark stained rectal type mucosa above and the unstained squamous epithelium below. Comparison with histological section shows that this zone corresponds with reasonable accuracy to the anal transitional zone.

Anal Canal↗
PubMed1977

Pathology of the anal glands with special reference to their mucin histochemistry.

The anal gland pathology comprises cystic anal glands (so-called anal gland cyst hamartomas), anal gland carcinomas, and anal fistulas with or without carcinoma. The differential diagnosis of these conditions from other cysts and carcinomas of the anal region can be difficult. The authors have therefore compared conventional history with mucin histochemistry in normal and pathological anal glands. In contrast to normal rectal mucosa the mucus of anal glands was characterized by strong PAS-reactivity that was completely abolished after periodate borohydride saponification indicating scarcity of absence of O-acylated sialic acids in the anal gland mucus. A pattern similar to this was found in one of two tumours classified histologically as anal gland carcinomas, in four of eight colloid carcinomas arising in preexisting fistulas, and in two cases of mucoepidermoid carcinoma of the anal region. The results indicate that the method in some cases may be of value in differentiating between carcinomas arising in anal gland epithelium and in rectal mucosa. The cystic anal glands showed decreased secretion but no qualitative histochemical differences from anal glands. On the basis of the patients' histories it is suggested that the so-called anal gland cyst hamartoma at least in some cases could be an inclusion cyst of anal glands on the inflammatory basis.

Adult↗