Risk of haemorrhage from transurethral prostatectomy in acetylsalicylic acid and NSAID-treated patients.

Postoperative bleeding in patients who regularly ingest acetylsalicylic acid (ASA) has been reported after several types of surgery. However, data on the influence of ASA on the risk of haemorrhage from transurethral prostatectomy (TUR-P) have been conflicting. We have studied retrospectively the unselected clinical records of all patients undergoing TUR-P in the Department of Urology at Hvidovre Hospital (during 1992-1994) with special focus on the use of ASA and non-steroidal anti-inflammatory drugs (NSAIDs). In total, 457 records were examined: 99 patients on ASA/NSAID received 42 units of blood, while 358 patients free from such medication received 68 units of blood, a significantly smaller amount (p = 0.0390). We conclude that ASA and NSAIDs increase the risk of bleeding during and after TUR-P, and we recommend the withdrawal of these drugs for one week before TUR-P.

[Local recurrence after low anterior resection of rectal cancer]. / Lokalt cancerrecidiv efter lav anterior resektion ved cancer recti.

Among 75 consecutive patients operated upon with anterior resection for rectal adenocarcinoma during a five year period, 29 (39%) developed local cancer recurrence. The total cumulative five-year survival was 49%, but only 17% in those with a local cancer recurrence. The most important risk factors for development of local recurrence were tumour fixation, intraoperative blood transfusion and surgical routine. Local recurrence was seen in 4/23 (17%) after operation performed by a consultant, 1/5 (20%) after a consultant-supervised operation and 24/47 (51%) after operation by a senior registrar (p < 0.02). As a consequence we recommend that operation for rectal cancer should only be performed or supervised by a few specialists in colorectal surgery.

Ophthalmoscopy for congenital hypertrophy of the retinal pigment epithelium (CHRPE) in patients with sporadic colorectal carcinoma.

In order to investigate the frequency of congenital hypertrophy of the retinal pigment epithelium (CHRPE) in sporadic colorectal cancer, ophthalmoscopy was carried out in 34 patients with colorectal carcinoma without known familial disposition. CHRPE is one of the most frequent extracolonic manifestations in familial adenomatous polyposis. None of the patients showed any sign of CHRPE. It is concluded that although genetic factors are presumably of importance in the development of sporadic colorectal cancer, CHRPE cannot be used as a marker for future risk of colorectal carcinoma except in polyposis families.

Closure of rectal stump after colectomy for acute colitis.

In a retrospective study complications, mortality and morbidity following acute colectomy for severe colitis with intra-abdominal closure of the rectal stump were reviewed in 147 consecutive patients (71 women and 76 men, median age of 40 years, range 18-95 years). Five patients (3%) died within 30 days postoperatively; none of the deaths were related to the rectal stump. Three patients (2%) had a pelvic abscess due to leakage of the rectal closure, all were treated successfully with percutaneous drainage, guided by ultrasonography. No difficulties in locating the rectal stump or performing intended subsequent surgery were reported. The overall complications and mortality rate in this study are low and comparable to the best results reported from centers using the mucous fistula. Closure of the rectal stump is a safe procedure, and has the advantage of not leaving the patient with a second stoma.

[Percutaneous endoscopic gastrostomy. A retrospective study of the course and complications]. / Perkutan endoskopisk gastrostomi. En retrospektiv opgørelse af forløb og komplikationer.

To assess mortality, morbidity and outcome of percutaneous endoscopic gastrostomy (PEG) we retrospectively studied 67 patients. PEG was successful in 65 patients (success rate, 97%). PEG was used as the procedure of choice when enteral feeding was needed. PEG was performed employing an introducer-technique and a Danish developed gastrostomy tube. The most common indication for PEG were neurological diseases (45 patients (69%)), trauma and malignant disorders (17 patients (26%)). Oral intake recovered in 18 patients (28%) who then had the tube removed, 25 patients (38%) were discharged with the gastrostomy, 13 patients (20%) died from their primary disease and five patients with PEG remained in hospital, PEG was removed in three patients due to intolerance to enteral feeding (two patients) or stomal leak (one patient). The total complication rate was 8% with three major complications (one procedure-related death). We recommend PEG for both short and long-term feeding.

The Acute Project in Nordland County, northern Norway. A presentation of acute referrals in 1990, and some of the questions raised from them.

This article describes the current Acute Project within Child and Adolescent Psychiatry in Nordland County, Norway. One of the aims of the project is to gather information about referrals defined as acute. The numbers of acute referrals for the whole county from 1990 are presented, together with more detailed information from the Salten district. The following variables regarding acute referrals are given attention: gender, age, problem description, diagnosis, and cooperation and consultation with other professional agencies. During clinical work in 1990, the opinions of clients and co-workers were gathered concerning which aspects of working with children and their families in crisis they considered as important. These covered both direct client work and work with larger systems. A summary of these considerations is presented.

Management of Peutz-Jeghers syndrome. Experience with patients from the Danish Polyposis Register.

Danish patients with Peutz-Jeghers syndrome are registered in the Danish Polyposis Register. We have initiated a new follow-up programme based on recent literature including our own cases. This has been adjusted to the regrowth rate of the polyps whereby patients with no symptoms and low regrowth rate are followed with few examinations. The programme includes upper and lower gastrointestinal endoscopy, small bowel enema and in cases with large or symptomatic polyps, laparotomy with intraoperative total enteroscopy with polypectomy as required. Pelvic examination, cervical smear, breast and testicular examination are carried out after the age of 30 years.