The aim of this exploratory study was to describe quality of life (QL) domains and independence in activities of daily living (ADL) in patients (n = 86) undergoing surgery for colorectal cancer. The patients were consecutively included, and two validated instruments, EORTC's QLQ-C30 and the Katz'/Hulter Asberg Index of Independence in ADL, were used preoperatively and at follow-up after 5-8 months. The findings were related to tumour localization, tumour burden according to Dukes' classification and to preoperative radiotherapy treatment. The results showed a significant improvement in the patients' scores for emotional functioning, appetite and global QL and a significant increase in financial impact at follow-up. The patients with colon cancer (n = 39) also had significantly less pain and less constipation at follow-up compared with preoperatively than did patients with rectal cancer (n = 47). The patients with rectal cancer, having undergone preoperative radiotherapy treatment, had significantly lower confidence intervals for means (95%) on the physical functioning and role functioning scales at follow-up versus preoperatively. Total ADL independence decreased from 70% of the patients preoperatively to 57% at follow-up, and independence in instrumental ADL decreased from 72% to 64% of the patients. No patient was dependent in personal ADL preoperatively, while 3% were dependent at follow-up. A lower mean score of global QL was found preoperatively and at follow-up for patients who were dependent in ADL than for patients who were independent in ADL. The instruments were found useful for evaluating individual patients in clinical practice.
Rebleeding was rare and occurred mainly during the first 4 months after operation, (n = 5) in 10% of the patients, and at the 24 month follow-up, (n = 4) in 11% of the patients. Portal flow was measured preoperatively in 33 patients and in 22 (67%) it was hepatopetal. During follow-up it was reversed and after 24 months no patient had hepatopetal flow. Hepatic encephalopathy was present in 18 patients (20%) during follow-up. Shunts thrombosed in 9 patients (15%), 8 of which required reoperation. There was no operative mortality, but 4 patients (7%) died within 30 days of surgery. The main late cause of death (18/26) was liver failure. The 1 year survival was 80%, the 3 year survival 70% and the 5 year survival 60%.
The mesocaval interposition shunt gives good longterm results and can be recommended both as an emergency and an elective procedure for patients with portal hypertension and bleeding oesophageal varices that are unresponsive to sclerotherapy.
One third of the total surgical care at the Department of Surgery, University of Lund, Sweden, is for cancer patients. Gastrointestinal cancer occupies 9,000 of a total of 12,000 bed-days and this disease is usually handled by the team who cares for the specific organ in which the cancer is localized. A particularly important part of gastrointestinal care is endoscopy (gastroscopy and colo-sigmoideo-rectoscopy). These diagnostic procedures can sometimes be curative. The value of preoperative liver tests for diagnosing liver metastases in colorectal cancer is very low because of the low prevalence of liver metastases in this population. Palliative therapeutical procedures, such as Celestin-tubes for esophageal or cardia carcinoma and transhepatic endoprostheses for bile duct occlusive cancer, have been tested. Palliative cytostatic therapy is partly established, i.e., intraarterial infusion of 5-FU for recurrent rectal carcinoma in the lower pelvis. This type of treatment has a very good pain relief effect. Cytostatic therapy for tumour control in patients without symptoms e.g. primary or secondary liver carcinomas, has not yet been established. Most of the patients with cytostatic therapy are treated on an outpatient basis. The cytostatic therapist must always be properly protected when working with cytostatic drugs. It is very important that the patient who gets cytostatic therapy is followed in order to see if the drug has any growth-controlling effect. A cost-benefit analysis of the therapy should also be made.
BACKGROUND: It has been reported that patients undergoing major hepatectomy tolerated 90 and 127 minutes of continuous hepatic inflow interruption with no evidence of permanent damage to the liver. We questioned the safety and feasibility of the interruption beyond 90 minutes in normothermic human beings. We also postulated that, besides injury to the liver per se, extended continuous hepatic inflow interruption would cause extrahepatic multiple-system organ damage in subjects exposed to continuous hepatic inflow interruption for 90 or 120 minutes. DESIGN: Fifty Sprague-Dawley rats were divided into three groups. Group 1 served as controls that had only laparotomy. Group 2 underwent continuous hepatic inflow interruption for 90 minutes, and group 3 was subjected to continuous hepatic inflow interruption for 120 minutes. Scanning electron microscopy and transmission electron microscopy were used to evaluate ultrastructural alterations in the liver, lung, heart, and intestine. SETTING: Lund (Sweden) University Hospital and Top Cancer Institute, Lund. INTERVENTIONS: Intraoperative and postoperative infusion and blood transfusion were given in all experimental animals. MAIN OUTCOME MEASURES: Animal survival and manifestations of multiple-system organ failure. RESULTS: In rats with continuous hepatic inflow interruption for 90 or 120 minutes, scanning electron microscopy showed a necrotic surface of the liver cells together with fibrin exudation. Hepatic sinusoids and intrahepatic nerves also had severe injury. Destruction of pulmonary structures and breakdown of microcirculation in the lung were characterized by thinned and ruptured walls of alveoli and a greatly decreased number of capillaries in the damaged alveolar wall. Transmission electron microscopy showed four types of ultrastructural changes, ie, necrosis of epithelial cells, extremely swollen mitochondria in intestinal cells, death of mucosal cells, and increased permeability of vessels in the injured intestine. The affected heart manifested highly enlarged mitochondria in myocardial cells, thickened vascular walls, and scattered necrotic lesions in myocardial tissue. CONCLUSIONS: Multiple-system organ failure resulting from ischemia-reperfusion injury and obstacle of portal hemodynamics in a subject subjected to an extended continuous hepatic inflow interruption is an unrecognized new disorder that may cause a high mortality rate. Our preliminary results indicated that animals subjected to continuous hepatic inflow interruption for 90 or 120 minutes developed various injuries to the liver, lung, heart, and gut. Therefore, we believe that continuous hepatic inflow interruption exceeding 90 minutes could also be hazardous in human beings.
AIM: The aim of this study was to evaluate the patterns of compliance and the frequency of adenomas and neoplasms in a Swedish population. METHODS: In 1996, 2000 men and women born in 1935 or 1936 were selected at random from the population registers of Uppsala and Malmö/Lund. All subjects were invited by mail to participate. In a randomised study design, subjects were either called up by a nurse to schedule the appointment for sigmoidoscopy or instructed to call themselves. At sigmoidoscopy subjects with a cancer, an adenoma (neoplastic polyp) or more than three hyperplastic polyps were scheduled for a complete colonoscopy. RESULTS: Thirty-nine percent (770/1988) of all the invited subjects had a sigmoidoscopy. The participation differed between the two centres, 47% at the Uppsala centre and 30% at the Malmö/Lund centre (P
In vivo colonization by different Lactobacillus strains on human intestinal mucosa of healthy volunteers was studied together with the effect of Lactobacillus administration on different groups of indigenous bacteria. A total of 19 test strains were administered in fermented oatmeal soup containing 5 x 10(6) CFU of each strain per ml by using a dose of 100 ml of soup per day for 10 days. Biopsies were taken from both the upper jejunum and the rectum 1 day before administration was started and 1 and 11 days after administration was terminated. The administration significantly increased the Lactobacillus counts on the jejunum mucosa, and high levels remained 11 days after administration was terminated. The levels of streptococci increased by 10- to 100-fold in two persons, and the levels of sulfite-reducing clostridia in the jejunum decreased by 10- to 100-fold in three of the volunteers 1 day after administration was terminated. In recta, the anaerobic bacterium counts and the gram-negative anaerobic bacterium counts decreased significantly by the end of administration. Furthermore, a decrease in the number of members of the Enterobacteriaceae by 1,000-fold was observed on the rectal mucosa of two persons. Randomly picked Lactobacillus isolates were identified phenotypically by API 50CH tests and genotypically by the plasmid profiles of strains and by restriction endonuclease analysis of chromosomal DNAs.(ABSTRACT TRUNCATED AT 250 WORDS)