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Biomedical subjects

Jacob Rosenberg

Publications and source records attributed to Jacob Rosenberg.

At least 19 recordsLinked to original sources
PubMed2006

[Dendritic cell-based cancer vaccine].

The varieties of treatments for patients with cancer have increased rapidly during the last few years. One of the newer ways to treat cancer patients is by immune therapy using tumor antigen pulsed dendritic cell-based vaccination. Phase I and II trials have shown effectiveness in generating an immunologic response and have in some cases shown clinical responses with tumour regression. This paper describes some of the possibilities and perspectives for dendritic cell vaccines for cancer patients.

Antigens, Neoplasm↗
PubMed2006

Fast-track giant paraoesophageal hernia repair using a simplified laparoscopic technique.

BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Adolescent↗
PubMed2006

Prevention of parastomal hernia by placement of a polypropylene mesh at the primary operation.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Adult↗
PubMed2006

No-trocar laparoscopic stoma creation.

Creation of an intestinal stoma may be necessary in a wide variety of colorectal diseases of both benign and malignant character. Open and laparoscopic techniques can be used for the fecal diversion. We report a case of a patient with a diverticulitis of the sigmoid colon with abscess formation and fistulation to the abdominal wall and vagina. Owing to severe comorbidity, a permanent fecal diversion was prepared. We performed a laparoscopic no-trocar technique. Only 1 incision, at the planned stoma site, was used. The abdominal wall was elevated with gaspers, no pneumoperitoneum or trocars were used. The laparoscope and reuseable laparoscopic graspers were introduced through the stoma site to correctly identify and grasp a loop of the terminal ileum. Finally, the loop ileostomy was placed on a bar. This laparoscopic technique is a valid alternative to standard laparoscopic stoma creation. Different techniques for stoma creation are discussed.

Aged, 80 and over↗
PubMed2006

The cognitive impact of nutritional homocysteinemia in apolipoprotein-E deficient mice.

Homocysteinemia is associated with cognitive dysfunction in the elderly ranging from subtle cognitive decline to dementia. Homocysteine is generated from methionine as a product of biological methylation reactions and is disposed of through reactions that require folate and vitamins B12 and B6. While different disruptions in these reactions can result in homocysteinemia, it is unclear if they will also result in homocysteine-mediated cognitive dysfunction. Young ApoE-deficient mice were fed one of four diets with differing methionine and B-vitamin content for eight weeks, before undergoing psychomotor tests, the Morris Water Maze test of spatial memory and learning, and measurement of home-cage activity. B-vitamin deficiency induced homocysteinemia and selectively impaired Morris Water Maze performance without affecting other behavioral measures. The cognitive deficits occurred in the absence of overt histologic neurodegeneration but in association with moderate impairments of brain methylation potential. Diets that yielded cognitive deficits were different from those that exacerbated aortic pathology. These findings are inconsistent with a single mechanism linking homocysteinemia to neurological dysfunctions mediated by homocysteine vasotoxicity. Instead, they indicate that different "types" of homocysteinemia, or in other words different impairments of nutritional metabolism affecting homocysteine levels, may lead to different end organ dysfunctions and/or diseases.

Animals↗
PubMed2005

[Elective treatment of colon cancer: surgical and oncological].

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.

Anastomosis, Surgical↗
PubMed2005

[Complications after treatment of colorectal cancer, with special focus on stomas, urological conditions and sexual dysfunction].

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.

Colorectal Neoplasms↗
PubMed2005

[A simple model for training basic laparoscopic skills].

We have designed a new kind of black box for training laparoscopic skills. The model is simple and cheap, which makes the opportunities for training much more available. The design is based on the use of a webcam. The model is not a closed box but a table with the camera placed underneath, transmitting the image of the task being performed up onto a computer placed where the surgeon can see it. The open model makes lights and optics unnecessary. We recommend this model for basic laparoscopic training.

Animals↗
PubMed2005

[Endoscopic treatment of gastroesophageal reflux disease].

Gastroesophageal reflux disease (GERD) is highly prevalent in the general population, and the treatment is mostly medical. However, lifelong therapy with proton pump inhibitors is expensive, and some patients with GERD have surgery because of unsatisfying symptom control, poor compliance or lack of acceptance of lifelong medical therapy. In the last couple of years, four endoscopic treatment options for GERD have evolved. These are endoscopic suturing, gastroplication, local radiofrequency treatment and injection of biopolymer into the gastroesophageal junction. The results so far have been promising regarding symptomatic control and patient satisfaction. The lack of normalized pH in the lower esophagus, however, and the lack of a physiological background for the impressing symptomatic effect, plus the fact that there has been only one sham-controlled randomized clinical trial, suggest that carefulness should be exercised in utilizing the procedures until more solid evidence is available. The methods in themselves are promising, though, and will probably have a natural position in the future treatment of GERD.

Catheter Ablation↗
PubMed2005

[Laparoscopic appendectomy].

Laparoscopic appendectomy is an effective, safe procedure for the treatment of patients with acute appendicitis. Studies have demonstrated the diagnostic and therapeutic advantages of the method and its positive impact on laparoscopic training. However, the procedure has not been widely accepted in Denmark. This paper describes the technical and educational aspects of laparoscopic appendectomy and provides practical information on the implementation of the procedure in daily practice.

Appendectomy↗
PubMed2005

[The Danish Cholecystectomy Database--DCD].

A Danish national database has been designed to monitor the quality of cholecystectomies. Data on each operation, surgeon, patient, length of hospital stay and complications are registered prospectively. Hospital departments will periodically be informed of their own and national results and will have continuous access to their own data for further analyses. A report on the nationwide data will be published and debated once a year after a thorough expert evaluation of the results in relation to defined risk factors. The database can be the basis for future clinical development and scientific investigations.

Cholecystectomy↗
PubMed2005

[Laparoscopic cholecystectomy as an outpatient procedure].

INTRODUCTION: The aim of this study was to describe our experience with laparoscopic cholecystectomy as an outpatient procedure in terms of complications, same-day discharge, and a registration of patient' postoperative pain, convalescence and contact with general practitioners. MATERIALS AND METHODS: A prospective evaluation was done of the first 231 patients undergoing laparoscopic cholecystectomy in an outpatient clinic. RESULTS: Ninety per cent of the patients were discharged directly from the outpatient clinic, and a total of 93% of the patients were discharged within 24 hours of the operation. The readmission rate was 1%. Leakage from the cystic duct occurred in one case (0.4%), and no other injuries to the bile ducts were observed. The conversion rate was 1%. Within a week 54% of the patients had no pain and 55% of the patients had resumed normal activity. Postoperatively, 25% of the patients had contact with a general practitioner due to wound and other complaints that required no intervention. DISCUSSION: Laparoscopic cholecystectomy is very suitable as an outpatient procedure due to its high same-day discharge rate and high patient satisfaction combined with low readmission and complication rates. Our study did expose, however, a high number of postoperative contacts with general practitioners due to non-surgical problems, which emphasizes the need for better patient information and cooperation with general practitioners to optimize the outpatient procedure further.

Adolescent↗
PubMed2005

[Outpatient laparoscopic cholecystectomy--two years of experience].

INTRODUCTION: By careful selection of both patients and surgeon, outpatient laparoscopic cholecystectomy can be performed in up to 90% of elective patients. The rate of same-day discharge in an unselected group scheduled for elective operation is, however, not clarified. MATERIALS AND METHODS: A clinical pathway for outpatient laparoscopic cholecystectomy was introduced as the standard procedure for all patients undergoing elective operation. The set-up allowed easy access to an overnight stay if needed. Hospital stay, complications, reasons for admittance, the need for medical advice after discharge, convalescence and patients" satisfaction were analysed. Prospective registrations were undertaken in a standard care plan, and a questionnaire was sent out after four weeks. RESULTS: During two years of the study, 535 patients had a cholecystectomy done. Of these, 403 were scheduled for elective laparoscopic operation and entered the clinical pathway. In 62% of the patients, the outpatient course was successfully completed, and 94% of the patients were discharged within 24 hours. In 2%, complications resulted in hospital stays longer than three days, and 2.7% of the operations were converted. About one third of the patients needed additional medical advice after discharge, and 4.3% of these were readmitted. Pain was among the most frequent complaints. The patients" satisfaction with the procedure was approximately 90%. DISCUSSION: In an unselected group of patients scheduled for elective laparoscopic cholecystectomy, about two thirds can be treated as outpatients with a high degree of safety and patients" satisfaction. Further development, especially in the multimodal treatment of pain, is still the most important area to focus on in order to reduce postoperative complaints and improve the course of convalescence.

Adolescent↗
PubMed2005

[Cholecystectomy in Denmark 1989-2003].

INTRODUCTION: The aim of this study was to describe the cholecystectomy rate in Denmark in the last 15 years, since the introduction of laparoscopic cholecystectomy might have had an influence on it. MATERIALS AND METHODS: An analysis was done of data from the mandatory Danish National Patient Registry, which covers all public hospitals in Denmark. All cholecystectomies performed from 1989 to 2003 in the various hospitals were registered. Open and laparoscopic operations were registered separately. In addition, the number of patients who were operated on for acute cholecystitis from 1996 to 2003 was registered. RESULTS: An increase in the cholecystectomy rate was observed, from 67/100,000 inhabitants in 1989 to 143/100,000 inhabitants in 2003 (p < 0.05). The increase was due mainly to the number of laparoscopic procedures, which comprised 81% of all cholecystectomies in 2003. The proportion of patients who were operated on for acute cholecystitis decreased from 14% in 1996 to 12% in 2003 (p < 0.05). DISCUSSION: The increasing cholecystectomy rate in Denmark from 1989 to 2003 is probably due to the fact that more patients are having surgery for painful gallbladder stones.

Cholecystectomy↗
PubMed2005

[Treatment of gallstone pancreatitis in Denmark].

INTRODUCTION: The aim of the study was to describe the treatment of gallstone pancreatitis in Denmark and to compare it to the recommendations given in the National Reference Programme for the treatment of patients with gallstone disease. MATERIALS AND METHODS: A questionnaire was sent to the 42 general surgical hospital departments in Denmark. RESULTS: All of the departments returned the questionnaire. All of them treated patients with gallstone pancreatitis; 40 of them performed laparoscopic cholecystectomy. The severity of gallstone pancreatitis was estimated in 29 departments. In patients with mild gallstone pancreatitis, 6 departments used ERCP in the evaluation of choledocholithiasis. In patients with mild gallstone pancreatitis who did not undergo an ERCP procedure with sphincterotomy, 13 departments performed laparoscopic cholecystectomy during the same admission after an acute attack. DISCUSSION: In agreement with the recommendations given in the National Reference Programme, the majority of Danish surgical departments used laparoscopic cholecystectomy in the treatment of patients with gallstone pancreatitis who had not undergone ERCP with sphincterotomy. To avoid the high recurrence of gallstone pancreatitis, laparoscopic cholecystectomy during the same admission is recommended. This recommendation was, however, followed by less than half of the surgical departments.

Acute Disease↗
PubMed2005

[Effect of laparoscopic cholecystectomy on the quality of life of patients with uncomplicated socially disabling gallstone disease].

INTRODUCTION: The indication for cholecystectomy in symptomatic, uncomplicated gallstone disease varies in the literature, and there is no international consensus. In Denmark, laparoscopic cholecystectomy is recommended for patients with uncomplicated cholecystolithiasis and socially disabling pain. Postoperative health-related quality of life on this indication is unknown. MATERIALS AND METHODS: A prospective consecutive study was conducted. Patients with uncomplicated cholecystolithiasis and socially disabling pain were included and underwent laparoscopic cholecystectomy in the department of day surgery. All patients had uncomplicated gallstone disease. An internationally validated questionnaire, the Gastrointestinal Quality of Life Index (GIQLI), was completed one week before and six weeks after the operation. The questionnaire comprises 32 questions covering five items related to gastrointestinal disease, and each question is rated on a scale of 0 to 4 points. The maximum GIQLI score (GIQLI total) is 128 points (32 x 4 points) and represents the best possible health-related quality of life. RESULTS: 75 consecutive patients (62 women) underwent uneventful operations. All patients returned the pre- and postoperative questionnaire. The median age was 42 years (range 18-69), the median body mass index was 26 (19-39) and the median operation time was 56 minutes (24-130). The median GIQLI total scores were 99 (33-127) and 112 (82-128) before and after operation, respectively (P < 0.001). Scores on all five sub-items were significantly improved as well. CONCLUSION: Laparoscopic cholecystectomy improves the health-related quality of life six weeks after the operation in patients with socially disabling, uncomplicated cholecystolithiasis.

Adult↗