Biomedical subjects

S Laurberg

Publications and source records attributed to S Laurberg.

At least 19 recordsLinked to original sources

PubMed1996

[Anus cancer].

The pathology, etiology and epidemiology of anal cancer (CA) and the treatment and prognostic factors are reviewed. CA is a rare disease. However, the incidence is rising and is now 0.7 per 100,000 women and 0.4 per 100,000 men in Denmark. The median age is 60 years. Smoking and infection with human papillomavirus or HIV increases the risk of CA. The most important prognostic factors are tumour size, depth of invasion, inquinal lymph node involvement, differentiation and DNA ploidy. Previously CA was treated with abdominoperineal resection. Now sphincter preserving treatment with radiotherapy either alone or in combination with chemotherapy is preferred in most centers. Its is unsettled whether combined treatment is superior to radiotherapy only. Careful follow-up is warranted in order to perform salvage surgery in case of recurrent disease.

Anus Neoplasms↗

PubMed1996

[Laparoscopy in suspected acute appendicitis. Experiences with the first 233 laparoscopies at a university hospital department].

In an initial stage of introducing laparoscopic appendicectomy, 233 patients with indication for surgical treatment were evaluated in an open prospective trial. Surgery was done by a total of 39 trainees on duty. The procedure was started as a diagnostic laparoscopy followed by laparoscopic appendicectomy if the appendix was macroscopically inflamed. If the appendix was normal, it was left in place. There were 51 patients with a macroscopically normal appendix. Subsequently, none of them suffered from appendicitis or any other disorder requiring surgery. In 182 patients with laparoscopically assessed inflamed appendix, laparoscopic appendicectomy was attempted. One hundred and forty-eight proved successful, whereas 34 were converted to an open operation, mainly because of limited experience with the laparoscopic technique. Wound infection occurred in two and intraperitoneal abscess in four patients (0.9% and 1.7%), respectively. There was only one complication (0.4%) directly related to the laparoscopic procedure, namely a coecal leak. In conclusion, in a teaching hospital, laparoscopic appendicectomy can be safely offered to patients where surgery is indicated due to suspicion of appendicitis.

Abdomen, Acute↗

PubMed1996

[Results of ileoanal reservoir surgery].

We report our surgical, late complications and functional outcome of 157 consecutive restorative proctocolectomies with an ileoanal J pouch at the Department of Surgery L, Arhus City Hospital. Nine patients had familial adenomatous polyposis, while 148 patients were operated for ulcerative colitis. All patients had a protecting ileostomy. There was no mortality. Surgical complications after J pouch: Six patients were reoperated, five due to intra-abdominal bleeding, one for ileus. There was only one pelvic abscess, and it was drained percutaneously. There were no fistulae, no anastomotic leakage and no early pouch removal. Surgical complications after ileostomy closure: Eight patients were reoperated; two due to wound infections, five for ileus and one due to a wound rupture. Late Complications: Four pouches were removed, due to incontinence, difficult evacuation, chronic pouchitis or Crohn's disease. There were three late pouchovaginal fistulae more than one year after surgery. Five patients had surgery for ileus, one for an intra-abdominal abscess, one for a perianal fistula and eight for incisional hernia. Functional outcome: One year after pouch surgery more than 90% of patients were satisfied with the operation, 2.2% had regretted and 3.6% were in doubt. The functional result was satisfactory in the majority of the patients, but 21.1% had one or more night evacuations and 13.9% had variable degrees of incontinence.

Adenomatous Polyposis Coli↗

PubMed1996

Long-term effect of vaginal deliveries on anorectal function in normal perimenopausal women.

PURPOSE: This study was undertaken to determine the long-term effects of vaginal deliveries on anorectal function in healthy perimenopausal women. METHODS: An observational study of 144 perimenopausal women living in the county of Aarhus, Denmark, aged 45 to 57 (mean, 50) years were randomly selected from the National Register. All women had delivered 0 to 6 (mean, 2) times 10 to 34 years before the investigation. Examinations describing pelvic floor function were measurements of perineal position at rest and descent during straining, anal mucosa electrosensitivity, maximum resting pressure and maximum squeeze pressure of the anal sphincters, and pudendal nerve terminal motor latency. All tests were performed by one of the authors (AMR) and without knowledge of parity. Data were analyzed using the multiple regression technique, and all associations between anorectal function and parity were corrected for age and hysterectomy status. RESULTS: Increasing parity correlated with a lowered perineal position at rest (correlation coefficient (r) = 0.26; P = 0.003), an increased descent during straining (r = 0.24; P = 0.006), an increased threshold of anal mucosa electrosensitivity (r = 0.22, P = 0.008), and an increased pudendal nerve terminal motor latency on both sides (r = 0.27; P = 0.002). No effect of parity of the maximum resting pressure (r = 0.06; P = 0.70) and maximum squeeze pressure (r = 0.06; P = 0.36) was found. The number of vaginal deliveries account for only a minor fraction of the total variability seen in the tests of pelvic floor function (between 1.6 and 5.7 percent). CONCLUSION: Repeated vaginal deliveries have a long-term adverse effect on anorectal physiology in a population of randomly selected healthy perimenopausal women.

Anal Canal↗

PubMed1995

Multiple vaginal deliveries increase the risk of permanent incontinence of flatus urine in normal premenopausal women.

PURPOSE: This study was undertaken to evaluate the risk of permanent flatus or urinary incontinence after repeated vaginal deliveries. METHODS: In 1989 a questionnaire on obstetric history and urinary and fecal incontinence was sent to a sample of 304 women selected from the birth records from 1976 to 1988; 242 responded (80 percent). RESULTS: Participants had one, two, or three vaginal deliveries, all without an obstetric tear of the anal sphincter. After the first, second, and third deliveries, 1.2, 1.5, and 8.3 percent developed permanent flatus incontinence. The risk was significantly increased after the third delivery compared with the first and second deliveries (odds ratio, 6.6; confidence interval, 2.4-18.3). Permanent urinary incontinence after the first, second, and third delivery developed in 3.3, 1.0, and 6.8 percent. The risk was significantly increased after the third delivery compared with the first and second (odds ratio, 3.2; confidence interval, 1.1-9.1). CONCLUSION: These results indicate that repeated vaginal deliveries increase the risk of minor anal and urinary incontinence, which were found to be a common problem in premenopausal women.

Adolescent↗

PubMed1995

Transmural trophic effect of short chain fatty acid infusions on atrophic, defunctioned rat colon.

PURPOSE: This study was designed to investigate and quantify trophic alterations in the defunctioned, atrophic rat colon after short chain fatty acid (SCFA) treatment was administered in a clinically relevant way. METHODS: Diverting colostomy with exclusion of distal colon was performed on adult female rats (58), and treatment was started four weeks later. Enemas of either a SCFA solution of sodium-acetate, sodium-propionate and sodium-butyrate (concentration, 780 mM), or isotonic saline (placebo) were instilled through the anus into the defunctioned colon. This was done twice daily for 7 or 14 days before death. RESULTS: After SCFA instillation for 14 days, the colonic wet weight was 18 percent higher compared with placebo (P < 0.01), and there was a similarly significant difference in dry weight (P < 0.05). Using stereologic assessment to determine the histologic composition of defunctioned colon, we found significant increases among SCFA-treated rats in the weight of the mucose (P < 0.05), the submucosa (P < 0.05), and the muscularis propria (P < 0.05) and a 30 percent increase in the mucosal surface area compared with placebo-treated in the mucosal surface area compared with placebo-treated rats (P < 0.05). Measurements of breaking strength and hydroxyproline content showed no differences between treatment groups. CONCLUSIONS: SCFA enemas have a transmural trophic effect and preserve mucosal surface area of defunctioned and atrophic colon in rats.

Acetates↗

PubMed1995

Impaired wound healing but unaltered colonic healing with increasing age: an experimental study in rats.

Age-related differences in the healing of left colonic anastomoses and abdominal incisional wounds were compared between young and old rats. Immediately after surgery the anastomotic strength (suture-binding capacity) was 67% higher in old rats corresponding to a 107% higher collagen content per unit length of left colon compared to young rats. After 2 and 4 days of healing there was no difference in the breaking strength of the anastomoses between young and old rats, although the increase in collagen content of the anastomosed segment was 100% in the young rats and only 35% in the old rats from day 2 to day 4. The healing of the abdominal incisional wounds was, however, impaired in old rats compared to young rats, since the tensile strength and the energy absorption on the 4th postoperative day was 67 and 57% lower, respectively. In conclusion, old rats have impaired skin healing, whereas colonic healing is not affected by age.

Aging↗

PubMed1995

Trophic effects of biosynthetic growth hormone on normal and defunctioned left colon in rats.

BACKGROUND: In rats with diverting colostomies the effects of growth hormone can be differentiated from the actions of fecal passage. METHODS: After sham operation or diverting colostomy rats were treated with biosynthetic growth hormone (b-hGH) for 4 weeks. RESULTS: In defunctioned colon of b-hGH-treated rats there were increases in mucosal surface area and the weight of mucosa and muscularis propria compared with the atrophic colon of saline-treated rats. The breaking strength of defunctioned colon rings was greater and the defatted dry weight and hydroxyproline content of these specimens were also increased. In intact colon b-hGH stimulated luminal surface area, the weight of mucosal and submucosal layers, and the hydroxyproline content compared with controls. The breaking strength was highest in specimens from saline-treated rats. CONCLUSIONS: B-hGH has a growth-promoting role throughout the whole thickness of the colonic wall in rats also in the absence of fecal passage.

Animals↗

PubMed1994

Diverting colostomy induces mucosal and muscular atrophy in rat distal colon.

The progress of adaptive changes in the left colon after diverting colostomy was studied in rats using stereological techniques. Standardised segments of left colon proximal and distal to the colostomy was examined after 0, 1, 2, 4, or 12 weeks. In excluded colon the mucosal weight was reduced by 37% (p < 0.01) and the luminal surface area by 47% (p < 0.01) after four weeks and reached a steady state at this point of time, as no further reduction was seen from 4 to 12 weeks. The number of proliferating crypt cells was determined immunohistochemically after in vivo labelling with bromodeoxyuridine and was compared with the total number of colonocytes. Total bowel rest leads to a reduction in the number of proliferating epithelial cells and not to a reduced average life span. The weight of the muscularis propria decreased by 32% after four weeks (p < 0.01) and by 48% after 12 weeks (p < 0.001), whereas the weight of the submucosa was unchanged. No adaptive changes were found in segments proximal to the colostomy. These results show that the wall composition of defunctioned colon in rats is radically changed resulting from a mucosal and muscular atrophy, and from a reduction in luminal surface area.

Animals↗

PubMed1994

Growth hormone treatment of rats with chronic diverting colostomy. Differential response on proximal functioning and distal atrophic colon.

Diversion of colon from the fecal stream leads to profound intestinal atrophy. After diverting colostomy for 4 weeks, female rats were treated with biosynthetic human growth hormone (b-hGH; 2.0 mg.kg-1 body wt.day-1) in order to investigate whether b-hGH could reverse atrophic changes in distal colon, with special reference to changes in morphometric composition, collagen content and biomechanical properties. Biosynthetic hGH treatment for 28 days stimulated growth of the muscularis propria of the defunctioned, atrophic colon (p < 0.05), whereas the mucosal atrophy was unaffected by the treatment. In colon proximal to the colostomy, however, b-hGH increased the colonic wet weight (p < 0.01), defatted dry weight (p < 0.005) and the collagen content (p < 0.05). Morphometric analysis showed that the growth increase was localized to the mucosa and the muscularis propria. In conclusion, fecal diversion alters the response of b-hGH treatment and indicates that the trophic effect of growth hormone on colonic mucosa is dependent on fecal bulk passage, whereas the trophic effect on muscularis propria is fully retained when colon is deprived of luminal nutrients.

Animals↗

PubMed1993

Decrease in collagenous proteins and mechanical strength of distal colon after diverting colostomy in rats.

The effects of a diverting colostomy on weight, collagen content, and biomechanical strength of the left colon was investigated in rats. Female rats received either a diverting colostomy or a sham-operation and were killed randomly 1, 2, 4, or 12 weeks after surgery. The dry weight and hydroxyproline content of excluded colon decreased by 37% (P < 0.001, confidence limits (CL) = 21-53%) and 25% (P < 0.001, CL = 18-31%), respectively, after 4 weeks, and by 52% (P < 0.001, CL = 38-66%) and 40% (P < 0.001, CL = 27-53%), respectively, after 12 weeks compared to sham-operated rats. The breaking strength of the defunctioned colon decreased by 21% (P < 0.05, CL = 2-40%) after 4 weeks and by 25% after 12 weeks (P < 0.05, CL = 4-46%). The tensile strength of defunctioned colon (load per unit collagen) was reduced by 19% after 4 weeks (P < 0.05, CL = 6-32%). Proximal to the colostomy site we found no differences in the hydroxyproline content or biomechanical strength. In conclusion, defunctioning of the left colon in rats leads to deterioration in the biomechanical properties caused by a lesser content and a decreased quality in the collagen of the left colon.

Animals↗

PubMed1993

Effect of growth hormone on the inflammatory activity of experimental colitis in rats.

The effect of daily treatment with 2.0 mg biosynthetic human growth hormone per kilogram body weight or isotonic NaCl (controls) on experimental colitis was investigated in rats. Colonic inflammation was induced by instillation of trinitrobenzene sulfonic acid (TNB) intraluminally into the left colon. Untreated NaCl-instilled rats were used for comparison with intact colon. Four days after TNB instillation the growth hormone-treated rats had lower macroscopic and microscopic damage scores and less infiltration of neutrophils, measured as myeloperoxidase activity (MPO), than controls. The biomechanical properties of the colon showed that the breaking strength and energy absorption were reduced in the control rats with colitis compared with intact colon, whereas the rats treated with growth hormone had unchanged strength and energy absorption. The differences in MPO activity, damage scores, and biomechanical properties were associated with a higher concentration of insulin-like growth factor I in serum from growth hormone-treated rats after 4 days than controls. Finally, the growth hormone-treated rats regained their initial body weight after 7 days, in contrast to the body weight of control rats, which remained 11% lower than their initial body weight.

Animals↗

PubMed1992

Risks of anal incontinence from subsequent vaginal delivery after a complete obstetric anal sphincter tear.

OBJECTIVE: To assess the influence of various risk factors on long term anal incontinence in women with a complete obstetric tear of the anal sphincter. DESIGN: Postal questionnaire. SETTING: Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark. SUBJECTS: 152 women with complete obstetric tear of the anal sphincter. MAIN OUTCOME MEASURES: Occurrence and duration of anal incontinence in relation to any delivery. RESULTS: 56 of 121 respondents had experienced a subsequent vaginal delivery; 23 (41%) of these had had transient anorectal incontinence directly after the complete tear and four (7%) had permanent anorectal incontinence. In the 23 women with transient anorectal incontinence directly after the complete tear, 9 (39%; 95% CI 19%-59%) developed anorectal incontinence after the next delivery, and this was permanent in four (17.4%; 95% CI 2%-33%). In the 29 women without anorectal incontinence after complete tear, two had transient incontinence of flatus but for less than 14 days after the next delivery. CONCLUSIONS: Transient anal incontinence after a complete tear is a predictor of anal incontinence after subsequent vaginal delivery. The major long term problem in our study of premenopausal women was incontinence of flatus. This possibility should be discussed with the women when a further pregnancy is planned.

Adult↗

PubMed1992

Intervention during labor: risk factors associated with complete tear of the anal sphincter.

Among 41,200 consecutive deliveries there were 152 cases of complete tear of the anal sphincter (complete tear). In a case-control design, the association between interventions during labor (forceps, vacuum extraction, use of oxytocin and prostaglandins and mediolateral episiotomy) and complete tear, were evaluated by confounder control using multiple logistic regression analysis. Controls chosen were the patients delivering just before and after the index patient with complete tear. Use of Kielland forceps, mediolateral episiotomy, shoulder dystocia and nulliparity were significantly associated with complete tear. Maternal age, presentation in labor, duration of second stage of labor and the indication for instrumental deliveries and episiotomy had no significant association with complete tear.

Adult↗

PubMed1991

Postoperative biosynthetic human growth hormone increases the strength and collagen deposition of experimental colonic anastomoses.

This study examined the effects of preoperative treatment with 2.0 mg biosynthetic human growth hormone (b-hGH)/kg/day on the bursting strength and collagen deposition of experimental left colonic anastomoses, and of intact colon from sham-operated rats. The anastomotic bursting pressure was 55% higher in the b-hGH treated animals on day 2 (p less than 0.05) and 79% higher on day 4 (NS; p = 0.056), and the bursting wall tension was 65% higher on day 2 (p less than 0.05) and 112% higher on day 4 postoperatively (p less than 0.05), than saline-injected controls. The hydroxyproline content of the anastomotic segment in the b-hGH treated rats increased by 56% on day 4 (p less than 0.005) and by 30% on day 6 postoperatively (p less than 0.05), compared with controls. At 3 cm proximal to the anastomoses the defatted dry weight and hydroxyproline content of the healing colons were increased after 6 days compared with the sham-operated rats. There was, however, no difference between the b-hGH treated rats and the paired controls, indicating that growth hormone is not involved in this process.

Anastomosis, Surgical↗

PubMed1991

Influence of bilateral oophorectomy and estrogen substitution on the striated anal sphincter in adult female rats.

A quantitative histologic analysis of the striated anal sphincter of 24-month-old virgin female rats was performed to evaluate the effect of oophorectomy and estrogen substitution. The oophorectomized rats had a 21% (11-31%, 95% confidence limits) reduction in the cross-sectional area of the striated muscle tissue compared with controls. This was due to a reduction in the mean cross-sectional area of the muscle fiber, whereas the number of fibers was unchanged. Although the relative amount of stromal tissue was increased in the oophorectomized rats, the total stromal tissue was unchanged. No difference in the cross-sectional area of muscle tissue was found between the estrogen-substituted, oophorectomized rats and controls. This indicates that the estrogen depletion in the oophorectomized rats has induced the reduction in muscle tissue in the striated anal sphincter.

Anal Canal↗

PubMed1991

Age-related changes in the striated anal sphincter in female rats. A quantitative morphometric study.

A quantitative histologic analysis of the striated anal sphincter of virgin female rats aged 2 months and 24 months was performed to evaluate age-related changes. A 27% (8% to 46%, 95% confidence limits) increase in the cross-sectional area of the muscle in the older rats was observed compared with the young. This was due to an increase in both muscle and connective tissue. There was hypertrophy of both the small and large muscle fibres without change in the number with age. No evidence of age-related degenerative changes in this muscle in the virgin female rat was found.

Aging↗

PubMed1990

Effect of postanal repair on progress of neurogenic damage to the pelvic floor.

Physiological evaluation of the anorectum and pelvic floor muscles was carried out in 18 patients before and 9-35 months after postanal repair for anorectal incontinence. Thirteen patients (72 per cent) were improved, but in these patients the fibre density in the external anal sphincter muscle and the pudendal nerve terminal motor latency were both increased after surgery. In the five patients not improved after surgery only a few unstable motor unit potentials could be recorded in the external anal sphincter muscle. In two of these patients the pudendal nerve terminal motor latency could not be recorded after surgery. We suggest that this progression in the neurogenic damage to the pelvic floor muscles after postanal repair may be caused by the operation, and that it may be responsible for the poor functional outcome noted in some patients.

Action Potentials↗