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Biomedical subjects

H H Raskov

Publications and source records attributed to H H Raskov.

12 recordsLinked to original sources
PubMed2002

Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition.

BACKGROUND: Postoperative organ dysfunction contributes to morbidity, hospital stay and convalescence. Multimodal rehabilitation with epidural analgesia, early oral feeding, mobilization and laxative use after colonic resection has reduced ileus and hospital stay. METHODS: Fourteen patients receiving conventional care (group 1) and 14 patients who had multimodal rehabilitation (group 2) were studied before and 8 days after colonic resection. Outcome measures included postoperative mobilization, body composition by whole-body dual X-ray absorptiometry, cardiovascular response to treadmill exercise, pulmonary function and nocturnal oxygen saturation. RESULTS: Defaecation occurred earlier (median day 1 versus day 4) and hospital stay was shorter (median 2 versus 12 days) in patients who had multimodal treatment. Lean body and fat mass decreased in group 1 but not in group 2. Exercise performance decreased by 44 per cent in group 1 but was unchanged in group 2. A postoperative increase in heart rate (HR) response to exercise was avoided in group 2. Pulmonary function decreased in group 1 but not in group 2. There was less nocturnal postoperative hypoxaemia in group 2. Cardiac demand-supply (HR/oxygen saturation ratio) increased in group 1 but not in group 2. CONCLUSION: Multimodal rehabilitation prevents reduction in lean body mass, pulmonary function, oxygenation and cardiovascular response to exercise after colonic surgery.

Aged↗
PubMed2001

[Recurrence and survival after conventional low anterior resection for rectal cancer].

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.

Adenocarcinoma↗
PubMed1999

[Systemic palliative chemotherapy with 5-fluorouracil and leucovorin in disseminated colorectal cancer].

Systemic palliative chemotherapy is usually regarded as ineffective in disseminated colorectal cancer, and the risk of toxic adverse effects is often considered a contraindication, as many patients are old and cannot be offered curative treatment. Randomized trials during the last decade have shown, however, that an effect on both survival and quality of life can be expected. Only casuistic reports of total remission have been published but a partial tumour response can be expected in 20-50% of patients. Toxicity is related to palliative chemotherapy and accelerated with old age (> 70 years). When disseminated colorectal cancer is diagnosed the possibility of palliative chemotherapy should be conferred with an oncologist.

Age Factors↗
PubMed1996

[Adjuvant systemic chemotherapy in colon cancer].

The prognosis for patients with cancer of the colon is dubious. An intendedly curative colon resection is performed in two-thirds of these patients, but half of them will subsequently die from metastatic disease. Randomized trials of adjuvant therapy with fluorouracil in combination with levamisole or leucovorin have shown significant benefit in terms of increased disease-free survival and overall survival. In 1990 adjuvant treatment was recommended as routine therapy in high risk patients in USA. A number of European countries are routinely treating high risk patients with Dukes' C coloncarcinoma. The recommendations are based on results from several cooperative trials reviewed in this article. Treatment related toxicity accelerates with increasing age but was acceptable in the reviewed trials. Adjuvant therapy is widely accepted as an important supplement to surgery in high risk patients. A Conference on the results and experiences now available should take place in the near future in order to establish a national consensus on adjuvant chemotherapy in Denmark. Patients with resected Dukes' C coloncarcinoma should receive adjuvant chemotherapy including 5-fluorouracil and leucovorin. Randomized trials are needed to establish the most effective regimens but "no-treatment" controls are no longer ethically acceptable.

Adjuvants, Immunologic↗
PubMed1995

[Combined radiotherapy and chemotherapy as adjuvant treatment of rectal cancer].

The prognosis following radical operation for rectal cancer is still dubious. There is urgent need for effective adjuvant treatment in order to control both local and distant recurrences. During the last years the use of combined adjuvant treatment (radiochemotherapy ) has increased both recurrence-free survival in several randomised trials. The trials are reviewed in this article. Adjuvant treatment has been recommended as standard therapy in the USA since 1990. Following the German national consensus conference in March 1994, adjuvant treatment is now being recommended in Germany as well. In several other countries in Europe adjuvant therapy is routinely being offered to high-risk colorectal cancer patients following the surgical procedure. The experiences and results that now are available ought to be discussed in the near future in order to establish a national consensus in Denmark.

Chemotherapy, Adjuvant↗
PubMed1995

[Adjuvant radiotherapy of rectal cancer].

During the past decades the effect radiotherapy as adjuvant treatment of rectal cancer has been investigated in several prospective randomized trials. Only a marginal effect has been demonstrated on overall survival rate (3-4%) whereas the local recurrence rate can be significantly reduced by 33-50%. Using modern techniques the side-effects can be reduced to an insignificant level. Patients with rectal cancer who are not entering randomized prospective trials should be considered for pre-operative radiotherapy. Patients should be staged by preoperative CT-scanning and endoluminal ultrasound. Additionally, a down-staging effect and a reduction in tumor-size can be expected and accordingly an increase in resectability rate and a higher rate of sphincter-saving operations for large of fixed tumors is likely to be obtained.

Humans↗
PubMed1985

Gas-producing perianal infection.

Five cases of nonclostridial, gas-producing perianal infection are reported and the resemblance to clostridial gas gangrene is discussed. The importance of early diagnosis followed by aggressive surgical debridement and prompt administration of broad-spectrum antibiotics is emphasized.

Abscess↗