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Biomedical subjects

L H Iversen

Publications and source records attributed to L H Iversen.

At least 19 recordsLinked to original sources
PubMed2007

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 2: long-term outcome.

OBJECTIVE: We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant literature starting from 1992. We selected hospital caseload, surgeon's caseload and surgeon's education, type of hospital, and surgeon's experience as variables of interest. Measures of outcome were recurrence-free survival and overall survival, and for rectal cancer frequency of permanent stoma. We reviewed the 34 studies according to tumour location: colonic cancer, rectal cancer, or colorectal cancer. We described the studies individually and performed a meta-analysis whenever it was considered appropriate. RESULTS: For colonic cancer, overall survival improved with increasing hospital caseload, odds ratio (OR) 1.22 [95% confidence interval (CI) 1.16-1.28], and surgeon's education. For rectal cancer, overall survival improved with increasing hospital caseload, OR 1.38 (95% CI 1.19-1.60), and, possibly by surgeon' education and experience. Cancer-free survival was strongly influenced by surgeon's education. The colostomy rate was less in high caseload hospitals, OR 0.76 (95% CI 0.68-0.85). For colorectal cancer, overall survival improved with surgeon's education. CONCLUSION: The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.

Colonic Neoplasms↗
PubMed2007

Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome.

OBJECTIVE: An association between caseload and outcome has been reported for complex surgical procedures. We systematically reviewed recent literature to determine whether caseload and surgical speciality are associated with short-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant publications starting in 1992. We selected hospital caseload and type, and surgeon's caseload, education and experience as variables of interest. Measures of outcome were postoperative morbidity, in-hospital and 30-day mortality, and for rectal cancer anastomotic leak. We stratified the 35 reviewed studies by tumor location: colonic cancer, rectal cancer, or colorectal cancer and described the studies individually. A meta-analysis was performed only when it was considered appropriate. RESULTS: For colonic cancer, postoperative morbidity was associated with surgeon's caseload and education. Postoperative mortality was strongly associated with hospital caseload (OR 0.64, 95% CI 0.55-0.73), and surgeon's caseload (OR 0.50, 95% CI 0.39-0.64). It was also influenced by surgeon's education and experience. For rectal cancer, we found no evidence of an association between the selected variables and short-term outcome, including frequency of anastomotic leak. For colorectal cancer, there was evidence for an association between postoperative morbidity and hospital caseload. CONCLUSION: Our review offers evidence for a positive association between high hospital caseload, surgeon's caseload, sub-speciality and experience and improved short-term outcome in colonic cancer surgery. We failed to find evidence of a relationship for rectal cancer surgery, possibly owing to methodological artifacts. No study reported an inverse relation.

Clinical Competence↗
PubMed2005

Population-based study of short- and long-term survival from colorectal cancer in Denmark, 1977-1999.

BACKGROUND: Survival rates for patients with colorectal cancer have been lower in Denmark than in other European countries. The aim of this study was to examine temporal trends in relative survival from colorectal cancer between 1977 and 1999. METHODS: All patients diagnosed with colorectal cancer between 1977 and 1999 were identified using the nationwide population-based Danish Cancer Registry. Patients were linked with the Danish Central Population Registry to obtain data on survival to December 2002, and to select ten population controls per patient. RESULTS: A total of 69 562 patients with colorectal cancer were identified, of whom 49.2 per cent were men. Six-month relative survival after diagnosis increased from 69.7 per cent in 1977-1982 to 77.7 per cent in 1995-1999. Five-year relative survival rates increased from 37.8 to 46.8 per cent respectively. Women had slightly higher 5-year relative survival than men throughout the study period. Rectal tumours were associated with better survival than colonic tumours until 2 years after diagnosis, after which tumour location had no impact on survival. CONCLUSION: Relative survival of patients with colorectal cancer has improved in Denmark between 1977 and 1999, most probably reflecting better management of the disease.

Adolescent↗
PubMed2002

Relationship of coagulation test abnormalities to tumour burden and postoperative DVT in resected colorectal cancer.

In a prospective study, coagulation test results were compared in 137 patients with colorectal cancer (CRC) and 39 subjects with benign colorectal diseases. Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and soluble fibrin (SF) were measured in plasma before and after surgery. CRC patients presented with significantly higher values of F1+2 and TAT than controls. Patients with localised CRC had elevated values of F1+2 and TAT, whereas patients with advanced CRC also had elevated SF values. TAT and SF levels correlated with tumour spread, and normal values virtually excluded advanced cancer. Postoperative deep venous thrombosis (DVT) was diagnosed by phlebography in 20% of the CRC patients. Preoperative values of the markers did not predict postoperative DVT, but postoperative values did.

Adult↗
PubMed1999

Systemic coagulation activation and anastomotic leakage after colorectal cancer surgery.

PURPOSE: The aim of the present study was to study whether patients developing anastomotic leakage after colorectal resections for colorectal cancer have laboratory signs of an altered hemostatic balance in the systemic circulation, preoperatively and postoperatively, causing an impaired healing process. METHODS: Patients operated on for colorectal cancer were studied. Seventeen consecutive patients with anastomotic leakage and 17 patients without anastomotic leakage were matched according to age, gender, tumor stage, and localization of tumor. Hemostatic balance was estimated preoperatively and at one, two, and seven days and at three months after surgery by plasma levels of sensitive markers of coagulation activation and fibrinolysis, i.e., prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, tissue-type plasminogen activator activity, and plasminogen activator inhibitor Type 1. RESULTS: Preoperatively, the hemostatic balance was comparable in patients with and without anastomotic leakage. In the early postoperative period, patients developing anastomotic leakage exhibited signs of systemic coagulation activation, i.e., elevated plasma levels of prothrombin fragment 1 + 2, thrombin-antithrombin complexes, soluble fibrin, and plasminogen activator inhibitor Type 1. The observed coagulation activation appeared before the anastomotic leakage became clinically evident. More patients with anastomotic leakage received perioperative blood transfusions than patients without leakage, despite the fact that duration of surgery and intraoperative blood loss were comparable in the two groups. CONCLUSIONS: Enhanced coagulation activity was observed postoperatively in patients developing anastomotic leakage after colorectal resections for colorectal cancer. Such a hypercoagulable state may contribute to the development of anastomotic leakage by facilitating formation of microthromboses in the perianastomotic area.

Age Factors↗
PubMed1996

Markers of fibrin formation in colorectal surgery: fibrinopeptide A and soluble fibrin.

Two markers of fibrin formation, fibrinopeptide A (FpA) and soluble fibrin (SF), were studied in order to elucidate whether they reflected intravascular fibrin formation in the same manner. Plasma was collected for measurements of FpA and SF in 34 patients during the course of colorectal surgery. Although both parametres reflected haemostatic activation postoperatively, covariation was neither observed preoperatively, nor on the second, third, and eighth postoperative days. At 3 months following surgery, however, FpA and SF was correlated. At that time, the activation of the coagulation system has ceased. The present results demonstrate a lack of correlation between these markers of fibrin formation during clotting activation. Quite different properties of the FpA and the SF molecules, different clearance rates and distribution volumes may explain the lack of correlation observed.

Adult↗
PubMed1996

Short-time stability of markers of coagulation and fibrinolysis in frozen plasma.

We studied the stability of three markers of coagulation (prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin III complexes (TAT), and soluble fibrin (SF)) in stored frozen plasma, in addition to one marker of fibrinolysis (total fibrinogen degradation products and fibrin degradation products (TDP)). All markers were measured using enzyme linked immunosorbent assays (ELISA). None of the markers changed significantly after initial freezing. F1 + 2 in plasma was stable following storage at -80 degrees C for 3 months. In plasma containing high SF levels stored at -80 degrees C, an insignificant time dependent trend towards decreasing plasma values was observed. TAT levels in plasma decreased significantly following 3 months at -80 degrees C. TDP levels in plasma showed some fluctuation when stored in freezer. Our results suggest that careful observation of the long time storage stability of protein components is demanded in clinical research.

Adult↗
PubMed1996

Fibrin and fibrinogen degradation products in plasma of patients with colorectal adenocarcinoma.

PURPOSE: The aim of the present study was to correlate the preoperative plasma levels of TDP in patients with colorectal cancer to tumor stage, metastasis, and postoperative thromboembolic complications. METHODS: Ninety-one patients with colorectal cancer, 20 patients with colorectal adenoma, and 71 patients without neoplastic lesions in the colon or rectum were included in this prospective study. Before surgery, total fibrin and fibrinogen degradation products (TDP) were measured in plasma of all patients with a specific enzyme-linked immunosorbent assay test. Phlebography was performed postoperatively in 82 of 91 patients with colorectal cancer. RESULTS: Median TDP in plasma of patients with colorectal cancer (805 (range, 339-5,024) ng fibrinogen equivalents (ngFE)) was significantly higher than TDP in patients with colorectal adenoma (591 (range, 417-1386) ngFE/ml) and TDP in patients without neoplastic lesions in the colon (632.8 (range, 180-2622) ngFE/ml; P < or = 0.003). In patients with colorectal cancer and liver metastasis, TDP in plasma (1085.5 (range, 468-5024) ngFE/ml) was significantly higher than in patients with localized tumor growth (753 (range, (339-2,780) ngFE/ml; P < or = 0.02). Twenty of 82 patients (24 percent) with cancer developed thromboembolic complications. TDP was preoperatively significantly higher in this group of patients (1,101 (range, 468-2,167) ngFE/ml) compared with patients without thromboembolic complications (753 (range, 339-5024) ngFE/ml; P < or = 0.04). CONCLUSION: Preoperative plasma levels of TDP were elevated in patients with colorectal cancer, especially in patients with liver metastasis and in patients developing postoperative deep venous thrombosis.

Adenocarcinoma↗
PubMed1996

Pre- and postoperative state of coagulation and fibrinolysis in plasma of patients with benign and malignant colorectal disease--a preliminary study.

This study was carried out in order to compare the coagulation balance in patients with colorectal cancer before and after surgical removal of tumor with an age matched non-malignancy control group. Furthermore, it was studied whether preoperative coagulation state in cancer patients was correlated to the postoperative development of deep venous thrombosis (DVT) diagnosed by venography. Plasma was collected preoperatively in 93 cancer patients and 30 controls, and postoperatively on day one, two, seven, and ninety in 88 cancer patients and 18 controls. Prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), and total fibrin(ogen) degradation products (TDP) were quantitated in plasma by enzyme linked immunosorbent assays (ELISA). As compared to controls, patients admitted for cancer treatment displayed significantly higher levels of F1 + 2 and TAT. Patients suffering from advanced colorectal cancer had significantly higher levels of TAT and TDP as compared to patients with localized colorectal cancer. Twenty-three percent of cancer patients developed DVT postoperatively. Preoperatively these patients displayed significantly higher TDP levels, and postoperatively higher levels of F1 + 2, TAT, and TDP compared to cancer patients without DVT. The marked activation of blood coagulation and fibrinolysis observed in all patients following major abdominal surgery was even more pronounced in patients not cured for cancer.

Adult↗
PubMed1995

Soluble fibrin in plasma before and after surgery for benign and malignant colorectal disease.

In a prospective study, plasma levels of soluble fibrin (SF) were assessed in 97 patients with colorectal cancer immediately before and 1, 2, 7, and 90 days after surgery, 18 patients undergoing surgery for benign colorectal disease serving as controls. Age distribution, routine blood analysis, duration of surgery, perioperative blood loss and anaesthesia was similar in the two groups. SF was quantitated using a commercial enzyme-linked immunosorbent assay. The preoperative plasma level of SF was normal in cancer patients as a whole. However, patients with disseminated colorectal cancer had higher levels of SF preoperatively compared to patients with localized colorectal cancer (p < 0.01) and controls (p < 0.005). On days 1, 2, and 7 days postoperatively, a rather pronounced increase in plasma SF was observed in cancer patients as well as in the controls. Three months after surgery, plasma SF had normalized in controls and in patients undergoing curative cancer treatment. Postoperative deep venous thrombosis (DVT) was detected in 23% of the cancer patients by means of phlebography. The preoperative values of SF in these patients were higher compared to patients not developing DVT (p < 0.05). Patients with colon cancer displayed higher SF in plasma than patients with rectal cancer (p < 0.05).

Adult↗
PubMed1987

Pre-admission screening of nursing home applicants: implications for home care.

An increasing number of states are developing programs to evaluate nursing home applicants prior to admission. The purpose of these Pre-Admission Screening (PAS) programs is to assure that nursing home placement is needed and appropriate. Both the number and scope of these programs have grown considerably in the last decade as states attempt to reduce inappropriate placements and control nursing home costs and utilization. The increase in PAS can have a significant impact on community services as clients are diverted from nursing homes to home care. This article uses the results of a recently completed national survey of state-administered PAS programs to indicate the impact of PAS on community care. PAs was defined as an on-site assessment of the need or appropriateness of nursing home care conducted by a disinterested third party prior to nursing home admission. State administrators of Medicaid and/or PAS in all states and the District of Columbia were contacted by phone to determine whether or not their state conducted PAS. States with PAS were sent a comprehensive mail survey, and 25 of these (81%) returned a survey. Data is presented regarding the scope of PAS programs, the types of clients participating in PAS, the variety of services coordinated or funded in conjunction with PAS, the types of recommendations made by screening teams (institutional vs. home care), and how respondents felt that PAS was impacting community services. The article concluded with a discussion of these results.

Data Collection↗
PubMed1987

State preadmission screening programs for controlling utilization of long-term care.

This article explores the issue o whether state-administered nursing home preadmission screening (PAS) programs are an effective means of controlling the utilization of long-term care. It is suggested that, overall, PAS may be increasing rather than decreasing the use of long-term care. Utilization control through PAS may be ineffective because it occurs too late in the placement decision process, there are insufficient placement alternatives, assessment tools do not adequately identify who is at risk of institutionalization, and policymakers and program administrators may have conflicting goals. Recommendations for improving the screening process include, among others, that States more clearly define program goals and that screening be conducted within a managed-care system.

Cost Control↗
PubMedDate not supplied

Pre-analytical variation in the measurements of sensitive markers of coagulation and fibrinolysis: the influence of venipuncture and mixing of blood.

The techniques adopted for venipuncture and the mixing of aspirated blood with anticoagulant were evaluated for their possible contribution in pre-analytical variation in estimating plasma prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), soluble fibrin and total fibrin(ogen) degradation products. Antecubital vein blood samples were simultaneously collected in 20 subjects from either arm by technologists with high and less blood sampling experience employing a crossover design. F1+2 and TAT were significantly higher in plasma obtained by a less experienced technologist. Three different mixing procedures of blood with anticoagulants did not influence the levels of the markers. The results emphasize that experienced technologists should preferably be selected for collecting blood for analysis of coagulation markers.

Antithrombin III↗