[Stomach cancer. A 10-year material with emphasis on early cancer]. / Ventrikkelkreft. Et tiårsmateriale med vekt på tidligkreft.

Between 1982 and 1991, 112 patients were treated for gastric cancer at Harstad Hospital in Northern Norway. Early gastric cancer accounted for 20% of all the adenocarcinomas (110), which is high compared with figures from other western studies. The role of endoscopy for detecting early gastric cancer is discussed. The five year survival rate after radical surgery was found to be significantly higher for patients with early gastric cancer than for patients who underwent curative surgery for either infiltrative or regional cancer. For patients with a tumour that had invaded the regional lymph nodes the five year survival rate was only 10%. This result can be improved by more extended lymph node dissection. The perioperative mortality rate (8%) was usually a result of severe cancer cachexia or underlying cardial disease, and not anastomotic leakage. The results as regards the cure of early gastric cancer are comparable with those described in other studies.

[Diagnosis and treatment of gastrointestinal hemorrhage]. / Diagnostikk og behandling av gastrointestinale blødningstilstander.

The handling of gastrointestinal bleeding was discussed at a national expert symposium in February 1995. Internists are in charge of therapeutic endoscopy of upper gastrointestinal bleeding at the majority of Norwegian hospitals, but close collaboration with the surgeon on call is vital. The need for intensive care and monitoring may have been underestimated, since decompensation of co-existing diseases is a more frequent cause of death than the haemorrhage itself. Endoscopic treatment is the primary choice in all parts of the gut where endoscopy is possible, but surgery must be considered for patients who rebleed. Injection of sclerosering agents is the most prevalent mode of treatment for oesophageal varices and ulcers, but thermal probes and rubber band ligation are probably equally effective in experienced hands. Major lower bowel haemorrhage can render colonoscopy impossible, and emergency resections may be warranted, but preferably after angiography or peroperative endoscopic localisation of the area of bleeding.

[Administrative handling of gastrointestinal hemorrhage in Norway]. / Administrativ håndtering av gastrointestinale blødninger i Norge.

Rapid and adequate endoscopic treatment is a vital part of the initial handling of gastrointestinal haemorrhage. A national survey was carried out to study the logistics of the initial handling of these patients. Replies were received from 97% of the hospitals, each of which received an average of 11 patients per month with haematemesis/melena or rectal bleeding. Patients with haematemesis or melena were admitted primarily to medical departments or intensive care units, while patients with haematochezia were admitted most often to the surgical department. 47% of the hospitals performed emergency endoscopy as a routine on patients with red haematemesis, but even in this group of patients, endoscopy was postponed until the first working day in some instances, provided that the patient's condition was stable. The majority of emergency flexible endoscopies are performed by internists, but most hospitals describe close inter-departmental cooperation in the handling of these patients. The situation was deemed satisfactory at 91% of the hospitals.

[Ischemic hepatitis. Important differential diagnosis of increased levels of transaminases in the liver]. / Iskemisk hepatitt. En viktig differensialdiagnose ved forhøyede levertransaminaseverdier.

In patients with pathological findings in tests of liver function, ischemic hepatitis is an important differential diagnosis. This condition is most often seen in patients with coronary heart disease. Acute circulatory failure may induce reduced liver perfusion with extreme elevation in transaminase levels within three to five days. The values return to normal within five to ten days and in uncomplicated cases there is minimal cholestasis. Ischemic hepatitis may progress to fulminant hepatic failure. The diagnosis can be made by clinical examination and biochemical tests alone. Biopsy gives a characteristic picture of centrilobular liver cell necrosis which confirms the diagnosis, but is seldom necessary.

[Chronic non-A non-B hepatitis treated with interferon]. / Kronisk non-A non-B-hepatitt behandlet med interferon.

Non-A non-B hepatitis remains a diagnostic and therapeutic problem. Recently published data indicate that interferon may represent a considerable step forward in the therapy of this disease. We have treated a patient with non-A non-B hepatitis with recombinant interferon alpha 2-B. Both biochemical and morphological liver parameters were normalized after nine months of treatment. Further studies are being performed to establish the efficacy and effective doses of interferon in the treatment of non-A non-B hepatitis.

[Schistosomiasis]. / Schistosomiasis.

Schistosomiasis ranks among the major public health problems in the tropics and subtropics. The disease is caused by the parasite Schistosoma, a flatworm with a life cyclus including man as the definitive host and a freshwater snail as the intermediate host. During the last ten years one hundred cases of this disease have been reported in Norway. We report two cases of schistosomiasis, one patient infected with Schistosoma japonicum, the first reported case in Norway, the other with Schistosoma mansoni and Schistosoma haematobium. We discuss the disease, including the clinical picture and treatment.

Value of sonography in obstructive jaundice. Limitations of bile duct caliber as an index of obstruction.

The diagnostic value of sonography was assessed in 176 patients with jaundice who had a final diagnosis on the basis of surgery, autopsy, liver biopsy, endoscopic retrograde cholangiopancreatography, and serum tests positive for hepatitis A and B. Obstructive (n = 113) versus nonobstructive jaundice (n = 63) was diagnosed with a sensitivity of 91% and a specificity of 95%. Nine of the 10 false negatives had choledocholithiasis. Application of stricter criteria for common duct (CD) dilatation than the one used of CD greater than or equal to 8 mm to greater than or equal to 12 mm would have lowered the sensitivity from 91% to 84%. On the basis of these criteria the predicted level of obstruction would have shifted from distal to proximal in 36% of the patients. Choledocholithiasis was more often associated with decreasing bilirubin values than malignancy: 55% versus 9% (p less than 0.05). The present study indicates that intermittent obstruction, usually associated with choledocholithiasis, constitutes the main problem in detection of obstructive jaundice. Diameter criteria used for diagnosing dilatation of the CD may greatly influence sonographic accuracy.

Local disodium cromoglycate is ineffective in ulcerative proctosigmoiditis.

Conflicting results have emerged from studies using oral and rectal disodium cromoglycate (DSCG) in inflammatory bowel disease. In the present double-blind study, 43 patients with active ulcerative proctosigmoiditis received either placebo (n = 22) or 600 mg DSCG (n = 21) rectally as enemas for eight weeks. Assessment was made from clinical investigations, endoscopy, laboratory tests, biopsies, and diary cards. No statistically significant differences in bowel frequency, rectal bleeding, general well-being, abdominal pain, and severity and extent of the disease were found between the groups during the study. There was no significant change in the histologic parameters. No side-effect was encountered. It is concluded that DSCG did not improve symptoms or inflammatory changes in ulcerative proctosigmoiditis.

Enzymatic activities in jejunal biopsy specimens from patients with the stagnant-loop syndrome.

The activity of the marker enzymes lactase, sucrase, neutral alpha-glucosidase, alkaline phosphatase, gamma-glutamyl transferase, leucyl-beta-naphthylamidase (brush border); 5-nucleotidase (basolateral membrane); and acid phosphatase and N-acetyl-beta-glucosaminidase (lysosomes) in jejunal biopsies from patients with the stagnant-loop syndrome and controls was studied. The activity of gamma-glutamyl transferase was increased in the patient group; the activity of the other enzymes did not differ significantly in patients and controls. The DNA to protein ratio was increased in the patient group. The results do not support the hypothesis of epithelial damage in the human stagnant-loop syndrome.

Hepatic telangiectasia in Osler's disease treated with arterial embolization. Report of 2 cases.

Hepatic hereditary telangiectasia in 2 females was treated with hepatic artery embolization. In one patient both peripheral and central arterial occlusion was performed; the patient died of massive gastro-intestinal bleeding for 2 months later. Autopsy showed extensive regions with necrosis in the right liver lobe. In the next patient only central occlusion of the right hepatic artery was performed and the arterio-venous shunting in the left liver lobe left remaining. After a long reconvalescence period the patient recovered completely. It is advocated to centrally occlude only that hepatic artery supplying the most affected parts of the liver in Osler's disease. Thus extensive necrosis with possible ensuing death may be avoided.

Effect of Nissen fundoplication operation on the competence of the lower esophageal sphincter.

The results of Nissen fundoplication operation were evaluated in 12 patients with hiatus hernia and gastroesophageal reflux before and 3, 6, and 12 months after the operation. Excellent clinical results as evidenced by absence of dysphagia, esophagitis, and radiological signs of reflux were obtained in 11 patients. One year after operation one patient developed renewed reflux and slight esophagitis, probably due to sliding of the fundoplication. The resting pressure of the lower esophageal sphincter (LES) increased from 5.4 +/- 5.8 cm H2O (mean +/- S.D.) before the operation to 11.8 +/- 5.0 cm H2O 3 months after operation (p less than 0.01). At 6 and 12 months the mean resting pressure (9.5 +/- 4.6 and 8.0 +/- 3.9 cm H2O, respectively) was not significantly different from the preoperative value. Compared with the preoperative LES pressure after pentagastrin stimulation (10.8 +/- 13.9 cm H2O) the pressure 3 months after operation had increased to 33.6 +/- 11.7 (p less than 0.001), after 6 months to 21.6 +/- 7.0 (0.05 greater than p greater than 0.02, and after 12 months to 22.1 +/- 9.0 cm H2O (0.05 greater than p greater than 0.02). In two patients the stimulated pressure decreased after 6 and 12 months; both are completely free of symptoms. We suggest that assessment of the competence of the LES after fundoplication by pressure measurement is of limited value.

Intensive treatment in severe acute attacks of ulcerative colitis.

The results of intensive treatment including steroids and early surgery in severe colitis in the period 1971-1975 were compared to the results from the period 1966-1970, when systematic intensive therapy was not given. The period of preoperative medical treatment was reduced on average from 31 to 17 days. Approximately half the patients went into remission in each period. In the period 1971-1975 (23 patients) there was no mortality during the acute attacks or in the subsequent follow-up period. In the period 1966-1970, the immediate mortality in 30 patients was 10% (3 patients). One patient died six years later at the age of 81 during a relapse of the colitis, and the overall mortality was 13.3%.