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Lars Aabakken

Publications and source records attributed to Lars Aabakken.

11 recordsLinked to original sources
PubMed2007

Familial adenomatous polyposis patients have high levels of arachidonic acid and docosahexaenoic acid and low levels of linoleic acid and alpha-linolenic acid in serum phospholipids.

Familial adenomatous polyposis (FAP) provides a model of APC inactivation as an early genetic event for the approximately 85% of colorectal cancers that develop from polyps. Abnormal fatty acid composition of tissues and serum phospholipids has been linked to cancer risk. Our aim was to describe the composition of fatty acids in serum phospholipids in 38 colectomized FAP patients as compared to 160 healthy subjects. Mean fatty acid intakes were similar between the groups. Colectomy was done on average 16 years prior to inclusion, and 18% were diagnosed with colorectal cancer at colectomy. The levels (weight %) of linoleic and alpha-linolenic acid were higher among the reference subjects (difference: 3.96, 95% confidence interval (CI) = 2.87, 5.04, and difference: 0.06, 95% CI = 0.04, 0.08, respectively), and the levels of arachidonic and docosahexaenoic acid were lower (difference: -3.70, 95% CI = -4.35, -3.06, and difference: -5.26, 95% CI = -6.25, -4.28, respectively) as compared to the FAP patients (all p < or = 0.0001). The abnormal fatty acid composition was not related to time since colectomy, intestinal reconstruction or history of colorectal cancer for any of the fatty acids assessed. Compositional differences in the fatty acid profile of serum phospholipids have not been described before in FAP patients. Further studies are needed to confirm these findings and assess clinical significances of a possible distorted fatty acid metabolism, including a potentially different dietary need of essential fatty acids. The relevance of these findings for APC induced cancers remains unclear.

Adenomatous Polyposis Coli↗
PubMed2006

Diagnostic benefit of biliary brush cytology in cholangiocarcinoma in primary sclerosing cholangitis.

BACKGROUND/AIMS: Primary sclerosing cholangitis (PSC) is associated with a high risk of cholangiocarcinoma development. Efforts should be made to detect early neoplastic changes that can be radically treated by liver transplantation. METHODS: In this prospective case series we obtained brush cytology specimens from bile duct strictures in 61 consecutive PSC patients. The cytological classifications were compared with histopathological findings in bile ducts from explanted livers or clinical outcome. RESULTS: Among patients with cytological low-grade (n=9; 15%) or high-grade dysplasia/adenocarcinoma (n=13; 21%), 8 (36%) proved to have cholangiocarcinoma and 7 (32%) to have high-grade dysplasia (i.e. cholangiocarcinoma in situ) in bile ducts from explanted livers. The sensitivity, specificity, positive- and negative predictive values, and accuracy of brush cytology in diagnosis of biliary malignancy were 100%, 84%, 68%, 100%, and 88% for the combination of low-grade and high-grade dysplasia/adenocarcinoma and 73%, 95%, 85%, 91%, and 90% for high-grade dysplasia/adenocarcinoma only. All patients with high-grade biliary epithelial dysplasia in explanted bile ducts were tumour free at follow-up. CONCLUSIONS: Brush cytology from bile duct strictures in PSC patients can detect cholangiocarcinoma in situ. Patients with cytological low-grade and high-grade dysplasia/adenocarcinoma are currently referred for liver transplantation in our hospital.

Adenocarcinoma↗
PubMed2006

[Clinical use of COX inhibitors--a consensus].

BACKGROUND: Many physicians have been uncertain about treatment options following reports that linked cyclooxygenase (COX) inhibitors to serious cardiovascular events and the subsequent withdrawal of two selective COX-2 inhibitors. Therefore, on June 14, 2005, the Norwegian Medicines Agency and the Department of Pharmacotherapeutics, University of Oslo, held an expert meeting on COX inhibitors. METHODS: Presentations and discussions based on existing literature and statements from European (EMEA) and American (FDA) medicine authorities. This constitutes the basis for the current recommendations. RESULTS AND INTERPRETATION: COX inhibitors have solely symptomatic effects, and there are no differences in analgesic and anti-inflammatory efficacy between the various COX-inhibitors. These drugs should, if possible, be used at the lowest effective dose and for as short a time as possible. Some of the COX-2 selective inhibitors show a lower incidence of gastrointestinal side effects than unselective COX inhibitors, but this advantage can be outweighed by increased occurrence of cardiovascular side effects. Generally, the cardiovascular adverse effects are more serious, and more often irreversible, than the gastrointestinal adverse effects. Patients with established or increased risk of cardiovascular disease should not use COX-2-selective inhibitors. In general, COX inhibitors should, if possible, not be administered to individuals with previous peptic ulcer disease, hypertension, heart failure, or kidney disease. There is a need for more data on the effect and safety of COX inhibitors.

Adult↗
PubMed2006

Diagnostic accuracy of magnetic resonance and endoscopic retrograde cholangiography in primary sclerosing cholangitis.

BACKGROUND & AIMS: To evaluate the accuracy and interobserver variability of magnetic resonance cholangiography (MRC) and endoscopic retrograde cholangiography (ERC) in the diagnosis of primary sclerosing cholangitis (PSC). METHODS: MRC at 1.5 T with thin- and thick-slice breath-hold technique was performed in 66 adult patients (median age, 44 y; 26 women) with an appropriate spectrum of hepatobiliary diseases. Maximum intensity projection images were reconstructed from the thin slices. ERC was performed within 48 hours of the MR examination. The reference standard of PSC diagnosis was based on a combination of clinical features and cholestatic biochemical profile with typical ERC and/or MRC abnormalities and supported by liver histology findings. Two independent reviewers who were unaware of final diagnoses analyzed all images retrospectively. RESULTS: PSC was diagnosed in 39 (59%) of 66 patients. MRC provided comparable and poorer depiction than ERC of extrahepatic and intrahepatic ducts, respectively. However, the diagnostic accuracy of ERC and MRC were comparable. In the MRC detection of PSC, the average sensitivity of 2 independent readers was 80%, the specificity was 87%, and the accuracy was 83%. The corresponding values for ERC were a sensitivity of 89%, a specificity of 80%, and an accuracy of 85%. Interobserver agreement for the diagnosis of PSC was good (kappa = .61) for MRC and excellent (kappa = .81) for ERC. CONCLUSIONS: PSC can be diagnosed with high accuracy and good interobserver agreement. MRC and ERC performed equally well in the diagnosis of PSC when used blinded to clinical information.

Adolescent↗
PubMed2005

Image documentation of endoscopic findings in ulcerative colitis: photographs or video clips?

BACKGROUND: Previous studies have shown deficiencies in the endoscopy reports and substantial interobserver variation in the assessments of endoscopic findings. The aim of this study was to determine how to perform systematic digital image documentation in ulcerative colitis and to evaluate if mucosal inflammation is assessed equally on a still image and on a video clip. METHODS: Eighteen video clips and their corresponding photographs that visualize different severities of ulcerative colitis were shown in randomized order to 20 experienced endoscopists. They assessed the mucosal inflammation of each image twice on a visual analog scale. Three comparisons were performed between the video clips, the photographs, and the video clips to the photographs, respectively. RESULTS: The mean score of the inflammation of the video clips at tape 1 and 2 was 4.74: 95% confidence interval (CI)[4.41, 5.08] and 4.90: 95% CI[4.56, 5.24), respectively, and of the photographs 4.53: 95% CI[4.19, 4.88] and 4.43: 95% CI[4.09, 4.77], respectively. The first answer explains 83% of the variation in the second answer for all comparisons, and the agreement index ranged from 0.38 to 0.42. CONCLUSIONS: The mucosal inflammation might be documented nearly as well with a still image as on a video clip. Systematic use of still images probably improves the endoscopy reports by adding more objective information about the mucosal inflammation.

Colitis, Ulcerative↗
PubMed2005

How useful are the Rome II criteria for identification of upper gastrointestinal disorders in general practice?

OBJECTIVE: The Rome II criteria are a classification of functional gastrointestinal disorders. It is not known whether they can be used as a diagnostic tool. This study evaluates the agreement between GPs and the Rome II criteria on the diagnosis of upper gastrointestinal disorders. MATERIAL AND METHODS: Consecutive patients with abdominal complaints were included in this pragmatic cross-sectional study. All patients answered a questionnaire based on the Rome II criteria. The diagnoses based on these criteria were compared with the GPs' diagnoses. RESULTS: A total of 549 consecutively selected patients were included in the study. The agreement between GPs and the Rome II criteria was 65%, kappa 0.34 (CI 0.27-0.41). The agreement was lower when dyspepsia and gastroesophageal reflux/functional heartburn were evaluated separately. The positive and negative predictive values of the Rome II criteria varied between 29-58% and 82-90%, respectively, in various groups of patients with confirmed diagnoses. CONCLUSIONS: The GPs' diagnoses differed from those based entirely on the Rome II criteria. Strict adherence to the criteria will result in other diseases being disregarded. The diagnoses of upper gastrointestinal disorders should be based on all available information and the Rome II criteria used only as an additional aid to improve the precise classification of functional disorders.

Adolescent↗
PubMed2004

Inter-observer agreement in the assessment of endoscopic findings in ulcerative colitis.

BACKGROUND: Endoscopic findings are essential in evaluating the disease activity in ulcerative colitis. The aim of this study was to evaluate how endoscopists assess individual endoscopic features of mucosal inflammation in ulcerative colitis, the inter-observer agreement, and the importance of the observers' experience. METHODS: Five video clips of ulcerative colitis were shown to a group of experienced and a group of inexperienced endoscopists. Both groups were asked to assess eight endoscopic features and the overall mucosal inflammation on a visual analogue scale. The following statistical analyses were used; Contingency tables analysis, kappa analysis, analysis of variance, Pearson linear correlation analysis, general linear models, and agreement analysis. All tests were carried out two-tailed, with a significance level of 5%. RESULTS: The inter-observer agreement ranged from very good to moderate in the experienced group and from very good to fair in the inexperienced group. There was a significantly better inter-observer agreement in the experienced group in the rating of 6 out of 9 features (p < 0.05). The experienced and inexperienced endoscopists scored the "ulcerations" significantly different. (p = 0.05). The inter-observer variation of the mean score of "erosions", "ulcerations" and endoscopic activity index in mild disease, and the scoring of "erythema" and "oedema" in moderate-severe disease was significantly higher in the inexperienced group.A correlation was seen between all the observed endoscopic features in both groups of endoscopists. Among experienced endoscopists, a set of four endoscopic variables ("Vascular pattern", "Erosions", "Ulcerations" and Friability") explained 92% of the variation in EAI. By including "Granularity" in these set 91% of the variation in EAI was explained in the group of inexperienced endoscopists. CONCLUSION: The inter-observer agreement in the rating of endoscopic features characterising ulcerative colitis is satisfactory in both groups of endoscopists but significantly higher in the experienced group. The difference in the mean score between the two groups is only significant for "ulcerations". The endoscopic variables "Vascular pattern", "Erosions", "Ulcerations" and Friability" explained the overall endoscopic activity index. Even though the present result is quite satisfactory, there is a potential of improvement. Improved grading systems might contribute to improve the consistency of endoscopic descriptions.

Colitis, Ulcerative↗
PubMed2004

Abdominal complaints in general practice.

OBJECTIVE: The study evaluates the prevalence and diagnoses of abdominal complaints in general practice, and compares characteristics and symptoms of patients with functional gastrointestinal disorders (FGIDs) and organic diseases. DESIGN: A cross-sectional study. SETTING: Nine centres with 26 participating general practitioners (GPs) in Norway. SUBJECTS: 3097 out of 3369 consecutive adult patients answered a questionnaire regarding abdominal complaints IN the last 3 months. Those who consulted for the complaints were eligible for this study. MAIN OUTCOME MEASURES: The GPs' diagnoses and patients' characteristics were reported in questionnaires. RESULTS: 460 out of 1499 patients with abdominal complaints consulted for these complaints; 392 were included in this study. The GPs diagnosed an FGID in 167 (42.6%) patients, organic disease in 145 (37.0%), and made no diagnosis in 80 (20.4%). Stress-related symptoms were a statistically significant predictor of a FGID (OR 1.95) and weight loss predicted in addition organic disease (OR 2.7) in 128 patients with a verified diagnosis. CONCLUSION: Abdominal complaints are a common problem in general practice. The distinction between FGID, which accounted for half of the diagnoses, and organic disease was difficult. The only significant predictor for FGID was stress-related symptoms.

Abdominal Pain↗