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Biomedical subjects

Søren Laurberg

Publications and source records attributed to Søren Laurberg.

At least 19 recordsLinked to original sources
PubMed2006

The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study.

OBJECTIVE: To compare sensitivity and specificity of contrast enhanced ultrasonography (CEUS) with conventional ultrasonography (US) in detection of liver metastases in patients with colorectal adenocarcinoma (CRC) in a patient-by-patient analysis. MATERIALS AND METHODS: A prospective study of 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. In order to detect possible liver metastases all patients underwent liver US, followed by CEUS by another investigator. Multislice CT scanning (MDCT), and intraoperative ultrasonography (IOUS) were then performed. Fine-needle biopsy was performed on all suspicious lesions. Each examination was interpreted blindly and the combination of biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS: Standard of reference found liver metastases in 54 patients (14.8%). Contrast enhanced ultrasonography improved the sensitivity significantly in detection of liver metastases from 0.69 by US to 0.80 (p=0.031). In 24 patients, CEUS found a higher number of metastases than US (p<0.001). The specificity (0.98) and the positive predictive value (0.86) was the same. CONCLUSION: Contrast enhanced ultrasonography improves sensitivity in detection of liver metastases in patients with CRC and in nearly half of the cases CEUS found a higher number of metastases than US.

Adenocarcinoma↗
PubMed2006

[Colorectal foreign bodies].

A patient with a retained anally introduced colorectal foreign body or complications hereof needs appropriate treatment. The patient may be in danger and is certainly in discomfort. The problem is relatively rare; however, its incidence may be expected to increase. Guidelines for handling of the situation are lacking in many textbooks. Here, a suggestion for handling of a patient with a retained colorectal foreign body or complications hereof is presented.

Colon↗
PubMed2006

Delay of treatment is associated with advanced stage of rectal cancer but not of colon cancer.

BACKGROUND: Dukes' stage is the most important predictor of prognosis of colorectal cancer, but the association between delay of treatment (DT) and Dukes' stage is still controversial. METHODS: From 1 January 2001 to 31 July 2002, we conducted a population-based prospective observational study based on 733 Danish colorectal cancer patients. DT was determined through questionnaire-interviews, and Dukes' stage was obtained from medical records and pathological forms. DT was classified into three groups: short (0-60 days), intermediate (61-150 days) and long (>150 days) DT. Dukes' stage was classified into two groups: non-advanced (Dukes' stage A or B) and advanced (Dukes' stage C or D) cancer. Using relative risk (RR) the association between DT and stage was estimated, with short delay as the reference group. RESULTS: The RR of advanced cancer was 1.0 (95% confidence intervals (CI): 0.8-1.3) for colon cancer patients with an intermediate DT, and 1.1 (95% CI: 0.9-1.4) for patients with a long DT. For rectal cancer patients the RR of advanced cancer was 1.9 (95% CI: 1.1-3.1) for patients with an intermediate DT and 2.1 (95% CI: 1.3-3.4) for patients with a long DT. CONCLUSION: DT was strongly associated with advanced stage of rectal cancer, but not of colon cancer.

Adenocarcinoma↗
PubMed2006

Frequent occurrence of uniparental disomy in colorectal cancer.

We used SNP arrays to identify and characterize genomic alterations associated with colorectal cancer (CRC). Laser microdissected cancer cells from 15 adenocarinomas were investigated by Affymetrix Mapping 10K SNP arrays. Analysis of the data extracted from the SNP arrays revealed multiple regions with copy number alterations and loss of heterozygosity (LOH). Novel LOH areas were identified at chromosomes 13, 14 and 15. Combined analysis of the LOH and copy number data revealed genomic structures that could not have been identified analyzing either data type alone. Half of the identified LOH regions showed no evidence of a reduced copy number, indicating the presence of uniparental structures. The distribution of these structures was non-random, primarily involving 8q, 13q and 20q. This finding was supported by analysis of an independent set of array-based transcriptional profiles, consisting of 17 normal mucosa and 66 adenocarcinoma samples. The transcriptional analysis revealed an unchanged expression level in areas with intact copy number, including regions with uniparental disomy, and a reduced expression level in the LOH regions representing factual losses (including 5q, 8p and 17p). The analysis also showed that genes in regions with increased copy number (including 7p and 20q) were predominantly upregulated. Further analyses of the SNP data revealed a subset of the identified alterations to be specifically associated with TP53 inactivation (including 8q gain and 17p loss) and lymph node metastasis status (gain of 7q and 13q). Another subset of the identified alterations was shown to represent intratumor heterogeneity. In conclusion, we demonstrate that uniparental disomy is frequent in CRC, and identify genomic alterations associated with TP53 inactivation and lymph node status.

Adenocarcinoma↗
PubMed2006

[Gastrointestinal surgery--why specialisation?].

Recent international data have documented improved postoperative outcome in relation to hospital and surgeon volume. Nation-wide Danish data have documented a high mortality and long hospital stay after abdominal cancer surgery, which is performed in a large number of departments. It is concluded that reorganisation with fewer surgical departments is required to improve outcome after major gastrointestinal surgery.

Centralized Hospital Services↗
PubMed2006

Urinary retention during sacral nerve stimulation for faecal incontinence: report of a case.

Sacral nerve stimulation (SNS) was proposed for the treatment of patients with urologic symptoms in 1967 but was not used until 1981. SNS has also proven to be a promising treatment in idiopathic faecal incontinence when conventional treatments have failed. The modality has been used for faecal incontinence since the mid-1990s. Eighty percent of the patients who were selected for percutaneous nerve evaluation (PNE) because of faecal incontinence report an improvement in the symptoms and qualify for a permanent implantation. Accordingly, SNS is now used for faecal incontinence and urologic symptoms. Reflex interactions between the bladder and the distal gastrointestinal tract are well known. The present case shows that SNS for faecal incontinence may significantly influence bladder function.

Adult↗
PubMed2006

Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation.

PURPOSE: Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves, and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation. METHODS: Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence score, rectal distention with thresholds for "first sensation," "desire to defecate," and "maximal tolerable volume," rectal pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up. RESULTS: Median Wexner incontinence score decreased from 16 (range, 6-20) to 4 (range, 0-12; P < 0. 0001). Median "first sensation" increased from 43 (range, 16-230) ml to 62 (range, 4-186) ml (P = 0.1), median "desire to defecate" from 70 (range, 30-443) ml to 98 (range, 30-327) ml (P = 0.011), and median "maximal tolerable volume" from 130 (range, 68-667) ml to 166 (range, 74-578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0-109) cm H(2)O to 38 (range, 0-111) cm H(2)O (P = 0.045). No significant increase in maximum squeeze pressure was observed. CONCLUSIONS: For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level.

Adult↗
PubMed2006

A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord-injured patients.

BACKGROUND & AIMS: Bowel dysfunction in patients with spinal cord injury often causes constipation, fecal incontinence, or a combination of both with a significant impact on quality of life. Transanal irrigation improves bowel function in selected patients. However, controlled trials of different bowel management regimens are lacking. The aim of the present study was to compare transanal irrigation with conservative bowel management (best supportive bowel care without irrigation). METHODS: In a prospective, randomized, controlled, multicenter trial involving 5 specialized European spinal cord injury centers, 87 patients with spinal cord injury with neurogenic bowel dysfunction were randomly assigned to either transanal irrigation (42 patients) or conservative bowel management (45 patients) for a 10-week trial period. RESULTS: Comparing transanal irrigation with conservative bowel management at termination of the study, the mean (SD) scores were as follows: Cleveland Clinic constipation scoring system (range, 0-30, 30 = severe symptoms) was 10.3 (4.4) versus 13.2 (3.4) (P = .0016), St. Mark's fecal incontinence grading system (range, 0-24, 24 = severe symptoms) was 5.0 (4.6) versus 7.3 (4.0) (P = .015), and the Neurogenic Bowel Dysfunction Score (range, 0-47, 47 = severe symptoms) was 10.4 (6.8) versus 13.3 (6.4) (P = .048). The modified American Society of Colorectal Surgeon fecal incontinence scores (for each subscale, range is 0-4, 4 = high quality of life) were: lifestyle 3.0 (0.7) versus 2.8 (0.8) (P = .13), coping/behavior 2.8 (0.8) versus 2.4 (0.7) (P = .013), depression/self perception 3.0 (0.8) versus 2.7 (0.8) (P = .055), and embarrassment 3.2 (0.8) versus 2.8 (0.9) (P = .024). CONCLUSIONS: Compared with conservative bowel management, transanal irrigation improves constipation, fecal incontinence, and symptom-related quality of life.

Anal Canal↗
PubMed2005

[Diagnostic strategy with respect to symptoms of colorectal cancer].

In relation to the risk of colorectal cancer, the population is divided into high-risk and average-risk groups. Patients at high risk are followed according to the national recommendations. Patients at average risk are examined according to their primary symptom(s). The strategy is based on the diagnostic strategy described in a Danish Health Technology Assessment published in 2001. The article states the recommendations for the high- risk groups and describes the value of the individual primary symptoms of colorectal cancer for average-risk patients and the examinations recommended accordingly.

Adult↗
PubMed2005

Human FK506 binding protein 65 is associated with colorectal cancer.

We initiated the present study to identify new genes associated with colorectal cancer. In a previously published microarray study an EST (W80763), later identified as the gene hFKBP10 (NM_021939), was found to be strongly expressed in tumors while absent in the normal mucosa. Here we describe this gene hFKBP10 together with its encoded protein hFKBP65 as a novel marker associated with colorectal cancer. Analysis of 31 colorectal adenocarcinomas and 14 normal colorectal mucosa by RealTime PCR for hFKBP10 showed a significant up-regulation in tumors, when compared with normal mucosa. Immunohistochemical analysis of 26 adenocarcinomas and matching normal mucosa, as well as benign hyperplastic polyps and adenomas, using a monoclonal anti-hFKBP65 antibody, showed that the protein was not present in normal colorectal epithelial cells, but strongly expressed in the tumor cells of colorectal cancer. The protein was also expressed in fibroblasts of both normal mucosa and tumor tissue. Western blot analysis of matched tumors and normal mucosa supported the finding of increased hFKBP65 expression in tumors compared with normal mucosa, in addition to identifying the molecular mass of hFKBP65 to approximately 72 kDa. Cellular localization and glycosylation studies revealed the hFKBP65 protein to be localized in the endoplasmic reticulum, and to be N-glycosylated. In conclusion, the protein hFKBP65 is associated with colorectal cancer, and we hypothesize the protein to be involved in fibroblast and transformed epithelial cell-specific protein synthesis in the endoplasmic reticulum.

Adenocarcinoma↗
PubMed2005

Age and colorectal cancer with focus on the elderly: trends in relative survival and initial treatment from a Danish population-based study.

PURPOSE: Elderly patients with colorectal cancer undergo surgery with curative intent less frequently than younger patients, and survival declines with increasing age. We compared relative survival of colorectal cancer among patients older than 75 years with that of younger patients in Denmark during the period 1977 to 1999. We also examined trends in choice of initial treatment. METHODS: From the files of the nationwide population-based Danish Cancer Registry, we identified all cases of colorectal cancer diagnosed between 1977 and 1999. We then linked this data to information on survival obtained from the Danish Register of Causes of Death and from the Central Population Register. RESULTS: During the entire study period, short-term and long-term relative survival improved for patients of all ages, but the improvement was more pronounced among elderly patients (>75 years). Radical resection was increasingly chosen as the initial treatment for elderly patients; during the 1995 to 1999 period it was performed on approximately 50 percent of such patients, almost as frequently as among younger patients. CONCLUSIONS: Relative survival of elderly colorectal cancer patients (>75 years) improved in Denmark between 1977 and 1999. In the most recent period studied, 1995 to 1997, only minor differences in five-year relative survival were observed among younger, middle-aged, and elderly patients. A simultaneous increase in the rate of radical resection among elderly patients, reflecting more effective treatment, may underlie this finding.

Adolescent↗
PubMed2004

Sacral nerve stimulation in fecal incontinence.

PURPOSE: The effect of sacral nerve stimulation was studied in 45 patients with fecal incontinence. METHODS: All patients were initially tested in general anesthesia. Sacral nerves 2, 3, and 4 were tested on both sides. If a perineal/perianal muscular response to sacral nerve stimulation could be obtained, electrodes were implanted for a three-week test-stimulation period. If sacral nerve stimulation resulted in at least a 50 percent reduction in incontinence episodes during the test period, a system for permanent sacral nerve stimulation was implanted. RESULTS: When tested in general anesthesia, 43 of 45 patients had a muscular response to sacral nerve stimulation and had electrodes implanted for the three-week test period. Percutaneous electrodes were used in 34 patients, and 23 of these had at least a 50 percent reduction in incontinence episodes, whereas the electrodes dislocated in 7 patients and 4 had a poor response. Permanent electrodes with percutaneous extension electrodes were used primarily in 9 patients and after dislocation of percutaneous electrodes in an additional 6 patients; 14 of these had a good result. In the last patient, no clinical response to stimulation with the permanent electrode could be obtained. A permanent stimulation system was implanted in 37 patients. After a median of six (range, 0-36) months follow-up, five patients had the system explanted: three because the clinical response faded out, and two because of infection. Incontinence score (Wexner, 0-20) for the 37 patients with a permanent system for sacral nerve stimulation was reduced from median 16 (range, 9-20) before sacral nerve stimulation to median 6 (range, 0-20) at latest follow-up ( P < 0.0001). There was no differences in effect of sacral nerve stimulation in patients with idiopathic incontinence (n = 19) compared with spinal etiology (n = 8) or obstetric cause of incontinence (n = 5). Sacral nerve stimulation did not influence anal pressures or rectal volume tolerability. CONCLUSIONS: Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.

Adult↗