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Biomedical subjects

Niels Qvist

Publications and source records attributed to Niels Qvist.

At least 19 recordsLinked to original sources
PubMed2006

[Appendicostomy in the treatment of severe defecation disorders in children].

INTRODUCTION: The Malone antegrad colonic enema (MACE) has been an option in the treatment of children with severe faecal incontinence or intractable constipation at Odense University Hospital. MATERIALS AND METHODS: We did a retrospective review of 32 case records and questionnaires completed by the patients. Pre-existing conditions included anorectal anomaly, myelomeningocele, Hirschsprung's disease and idiopathic constipation. The mean age at operation was 8.7 years (range 4-16 years), and the mean follow-up time was 2.5 years (range 1-8 years). RESULTS: Of the 32 patients, 31 returned the questionnaire. Three children had obtained satisfactory colonic function, and 2 patients had had a colostomy because of an unsatisfactory result. Of the remaining 26 patients, all reported improvement and 46% were completely clean. Complications related to the stoma included stomal stenosis (41%) and stomal leakage (62%), and 54% had experienced some degree of abdominal pain during the procedure. The patients' satisfaction with the MACE procedure and their improvement in general well-being was evaluated on a scale from 1 to 10 (1 = no satisfaction/improvement; 10 = fantastic satisfaction/improvement). The results ranged from 5 to 10 (mean 9). The same results were achieved regarding well-being. CONCLUSION: The MACE is a successful management option in children with faecal incontinence or intractable constipation. Patients' stool pattern, quality of life and satisfaction are greatly improved. However, the method is not without problems.

Adolescent↗
PubMed2005

[Alternatives to cholecystectomy].

Watchful waiting is the most important alternative to cholecystectomy in patients with uncomplicated gallstone disease. Symptom relief occurs in a large percentage of the patients, and the risk of developing complications is relatively small. However, in patients with a long life expectancy the cumulative risk may be significant, which must be taken into consideration. Extracorporal shock wave lithotripsy and medical treatment play a very small role in the treatment, and only on very special indications. The results of these methods are relatively poor and associated with a high recurrence rate.

Cholecystectomy↗
PubMed2005

Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer.

PURPOSE: Adjuvant radiotherapy in the treatment of rectal cancer has been shown to increase long-term morbidity causing severe anorectal dysfunction with physiologic changes whose interaction remains poorly understood. This study examines long-term anorectal morbidity from adjuvant postoperative radiotherapy. METHODS: In a prospective study, patients with Dukes B or C rectal carcinoma were randomized to postoperative radiotherapy or no adjuvant treatment after anterior resection. The long-term effect of radiotherapy on anorectal function in a subset of surviving patients was assessed from a questionnaire on subjective symptoms and from physiology laboratory evaluation and flexible sigmoidoscopy. RESULTS: Twelve of 15 patients (80 percent) treated with radiotherapy had increased bowel frequency compared with 3 of the 13 patients (23 percent) who did not have radiation therapy (P = 0.003). The former group had loose or liquid stool more often (60 vs. 23 percent, P = 0.05), had fecal incontinence more often (60 vs. 8 percent, P = 0.004), and wore pad more often (47 vs. 0 percent, P = 0.004). They also experienced fecal urgency and were unable to differentiate stool from gas more often. Endoscopy revealed a pale and atrophied mucosa and telangiectasias in the irradiated patients. Anorectal physiology showed a reduced rectal capacity (146 vs. 215 ml, P = 0.03) and maximum squeeze pressure (59 vs. 93 cm H2O, P = 0.003) in the radiotherapy group. Impedance planimetry demonstrated a reduced rectal distensibility in these patients (P < 0.0001). CONCLUSIONS: Adjuvant postoperative radiotherapy after anterior resection causes severe long-term anorectal dysfunction, which is mainly the result of a weakened, less sensitive anal sphincter and an undistensible rectum with reduced capacity.

Aged↗
PubMed2005

J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis: functional outcome, satisfaction and impact on social life.

OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents <18 years with ulcerative colitis. METHODS: Data were extracted retrospectively from medical records and obtained by mailed questionnaire. RESULTS: Thirty patients (18 girls) with a median age of 15 years (range, 7-17 years) were identified. Two patients (7%) had the J-pouch removed because of intractable diarrhea. Twenty-seven of 28 patients with preserved J-pouch answered the questionnaire. The median follow-up was 3.7 years (range, 0.3-9.2 years). Surgical complications included eight of 30 patients (27%) with small bowel obstruction, one of 30 (4%) with intra-abdominal abscess and two of 30 (7%) with perforation of the small intestine. The median number of daytime bowel movements was six (range, 3-10) and the median number of nighttime bowel movements was one (range, 0-2). Twelve patients (44%) were completely continent for stool and mucus, 12 patients (44%) leaked now and then and three (12%) leaked often or always. Antibiotic treatment for pouchitis was given in 13 patients (48%). Seventeen patients (63%) were completely satisfied with the operation, nine patients (33%) found the result fairly good and one patient (4%) was not satisfied. Twenty-six patients (96%) reported their health as completely or fairly good. CONCLUSIONS: The majority of patients with an intact J-pouch had an acceptable functional result with respect to defecation frequency, continence and number of pouchitis episodes. Most patients reported being satisfied with the procedure.

Adolescent↗
PubMed2004

Congenital diaphragmatic hernia: a survey of practice in Scandinavia.

There is no consensus on the treatment of congenital diaphragmatic hernia (CDH), and practice seems to vary between centres. The main purpose of the present study was to survey current practice in Scandinavia. Thirteen paediatric surgical centres serving a population of about 22 million were invited, and all participated. One questionnaire was completed at each centre. The questionnaire evaluated management following prenatal diagnosis, intensive care strategies, operative treatment, and long-term follow-up. Survival data (1995-1998) were available from 12 of 13 centres. Following prenatal diagnosis of CDH, vaginal delivery and maternal steroids were used at eight and six centres, respectively. All centres used high-frequency oscillation ventilation (HFOV), nitric oxide (NO), and surfactant comparatively often. Five centres had extracorporeal membrane oxygenation (ECMO) facilities, and four centres transferred ECMO candidates. The majority of centres (7/9) always tried HFOV before ECMO was instituted. Surgery was performed when the neonate was clinically stable (11/13) and when no signs of pulmonary hypertension were detected by echo-Doppler (6/13). The repair was performed by laparotomy at all centres and most commonly with nonabsorbable sutures (8/13). Thoracic drain was used routinely at seven centres. Long-term follow-up at a paediatric surgical centre was uncommon (3/13). Only three centres treated more than five CDH patients per year. Comparing survival in centres treating more than five with those treating five or fewer CDH patients per year, there was a tendency towards better survival in the higher-volume centres (72.4%) than in the centres with lower volume (58.7%), p =0.065.

Cross-Sectional Studies↗
PubMed2002

Lateral sphincteromyotomy in patients with outlet obstruction after surgery for Hirschsprung's disease and short-segment disease.

The results of lateral sphincteromyotomy (LSM) including the external sphincter in patients with severe outlet obstruction (OO) and constipation refractory to medical treatment after surgery for Hirschsprung's disease (HD) or with short-segment disease were evaluated. The parents filled out a detailed questionnaire on the child's bowel habits prior to surgery and at follow-up 2-26 months after surgery. The postoperative questionnaire included a 10-grade visual analog scale (VAS) indicating the general effect of LSM on the child's bowel habits: grade 1 represented no change at all and 10 represented an excellent result with normal bowel habits. 15 (65%) of the 23 patients had a VAS score of 7 or more, and 7 were reported to have normal bowel habits. Patients with a previous Soave operation did better compared to patients with short-segment disease (SSD). In 2 patients (Soave's operation) with scores of 1 and 2, respectively, a sigmoidostomy was performed 4 and 6 months after the LSM. High-dose laxatives and/or enemas have been used in the 5 patients with scores of 3-5. One patient developed a perianal abscess and one experienced minor soiling. LSM including the whole sphincter complex thus gave significant symptomatic relief in two-thirds of the patients. However, the long-term results are still pending.

Adolescent↗
PubMed2002

Congenital diaphragmatic hernia in Scandinavia from 1995 to 1998: Predictors of mortality.

BACKGROUND/PURPOSE: There is a lack of large contemporary studies on the management of congenital diaphragmatic hernia (CDH), and the prediction of mortality remains difficult. The aim of this study was to investigate the influence of perinatal factors on mortality rate in a contemporary multicenter study. METHODS: The authors conducted a retrospective multicenter cohort study. Twelve of 13 Scandinavian pediatric surgical centers participated in the study. During a 4-year period (1995 through 1998) 195 children with CDH were included. The main endpoints were hospital mortality rate and total mortality rate (before 2001). Bivariate and multivariate survival analyses were performed using Kaplan-Meier plots, Log-rank test, and Cox regression. RESULTS: Overall hospital mortality rate was 30%. Among 168 neonates with symptoms within 24 hours (early presenters) 35% died before discharge. All 61 deaths occurred in 157 neonates with symptoms within the first 2 hours of life. Among early presenters, 27% had prenatal ultrasound diagnosis, 26% were delivered by cesarean section, and 21% had associated major malformations. Bivariate analysis of early presenters showed increased risk of death in neonates with prenatal diagnosis, associated anomalies, right-sided diaphragmatic hernia (RCDH), low 1-minute and 5-minute Apgar scores, low birth weight, short gestational age, and cesarean delivery. Neonates with prenatal diagnosis were characterized by significantly lower Apgar scores, lower birth weight, and increased frequency of associated anomalies than those diagnosed after birth. Multivariate analysis found that prenatal diagnosis (P =.004), 1-minute Apgar (P =.001), and RCDH (P =.042) were independent predictors of total mortality rate. CONCLUSIONS: In a series of 195 CDH patients, all 61 deaths occurred in the 157 neonates presenting with symptoms within the first 2 hours of life. Prenatal diagnosis, 1-minute Apgar score, and RCDH were significant independent predictors of total mortality.

Cohort Studies↗