Lennart Leandoer

Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma

The progress of 139 patients operated upon for cure of colorectal carcinoma, was followed postoperatively with a standardized protocol. A CEA test was performed for comparison with other parameters. Median observation time was four years. When an upper limit for CEA of 7.5 μg/l was allowed, sensitivity was found to be 78 per cent, specificity 91 per cent, and predictive value of an elevated CEA concentration, 83 per cent. In general, CEA measurement traced, recurrence six months before clinical diagnosis. In only a few cases was recurrence first heralded by an abnormality in other blood chemistry test results. CEA may thus be used in postoperative screening for recurrence even though most recurrences, when detected, are not curable.

Surgery for fulminating colitis during pregnancy

Two cases of fulminating colitis presenting during pregnancy are described. In both cases, resectional surgery was performed. In the first case, cesarean section was combined with subtotal colectomy and ileostomy during the 32nd week of gestation. In the second case, cesarean section was performed during the 33rd week of gestation and proctocolectomy in the puerperium. In both cases, histopathologic examination showed colitis more consistent with Crohns disease. It is concluded that if fulminating colitis appears during pregnancy it should be treated in the same manner as in the nonpregnant state.

Crohn's disease confined to the appendix

Crohns disease confined to the appendix is a rare entity, less than 50 cases having been reported. The present study reports on another 12 cases representing 6 per cent of all 194 patients operated upon for Crohns disease in a total, unselected series. The indications for surgery were appendicitis in eight patients, appendiceal abscess in two, suspected pyosalpinx in one, and an ovarian cyst in one. The appendices were in all cases strikingly enlarged. Giant-cell granulomas, without microabscesses, were detected in all but one patient. Two patients had early septic postoperative complications. Fistulization from the cecum did not occur. The median observation time after operation was 13.8 years. Since none of the patients had further manifestations of the disease, it is concluded that patients with Crohns disease confined to the appendix have a favorable prognosis.

Pre- and Post-Operative Complications in Crohn's Disease with Special Reference to Duration of Preoperative Disease History

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohns disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohns disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohns disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.

Evaluation of possibilities for mass screening for colorectal cancer with Hemoccult fecal blood test.

Data from a health survey including the Hemoccult® fecal blood test, together with official cause-specific death rates, were used to assess the magnitude of a controlled trial that would be required to prove a 25 percent reduction of the mortality from colorectal cancer associated with screening. All men in three age groups in the city of malmö, Sweden, were invited, but 46 percent did not participate in, the Hemoccult screening. One carcinoma and 89 adenomas were detected in 56 of the 2422 who did. With the risk function used in our calculation and a complicance rate of 60 percent, a study population among 45- to 69-year-olds of 605,000 is required to prove an expected 25 percent reduction of the mortality with 90 percent power. Considering the size of such a trial, we question whether a controlled trial is feasible. With known risk functions for death from all causes and death from colorectal cancer, the study population was calculated using variable statistical power, participation rate, and risk reduction. Statistical methods and computer programs are given. In addition, alternative study models to assess the benefits associated with screening are discussed.

Carcinoma of the Anal Canal

A 20-year retrospective study of all anal canal carcinomas in the city of Malmö has been performed. The series consists of 29 patients, 23 women and 6 men, with a mean age of 66 years. Eight patients had non-keratinizing squamous cell carcinoma, 7 had keratinizing squamous cell carcinoma, 12 had basaloid squamous cell carcinoma, and 2 patients had mucoepidermoid carcinoma. Two of four patients operated on for curative purposes with local excision survived 5 years, as did seven of nine patients operated on curatively with abdominoperineal resection. In discussing the results, an overview of the literature is presented. It is concluded that adjuvant combined chemotherapy and radiotherapy appears to result in a higher survival rate for patients with tumours growing at or above the dentate line.

Localized colitis cystica profunda.

Radiologic reports of colitis cystica profunda are scarce, and on account of this most radiologists are unfamiliar with the radiologic appearance of the disease. In 10 cases the radiological appearance and clinical symptoms are described. In all cases the lesions were located in the rectum, and in the involved segments there were longitudinal, thickened mucosal folds and one or several polypoid lesions of various sizes, which strongly suggest the radiographic diagnosis of localized colitis cystica profunda.

Coagulation and Fibrinolysis After Renal Transplantation

Coagulation factors and components of the fibrinolytic system were studied in patients before, and for the first 3 weeks after, renal transplantation. The activity of the inhibitors of plasminogen activation by urokinase in patients as followed up for up to 2 years after transplantation. Before transplantation the bleeding time was slightly prolonged, and the platelet adhesiveness was decreased, sometimes severely. The fibrinogen concentration was slightly raised. Like other major operations, transplantation was promptly followed by a fall of the fibrinogen, P & P, factor VIII and plasminogen, presumably a reaction to surgical intervention per se. But unlike other operations, transplantation was not followed by later increase of the fibrinogen level. The bleeding time and platelet adhesiveness became normal, which can be ascribed to the disappearance of the uraemia. The inhibitors of plasminogen activation by urokinase increased merkedly and their activity was still high in patients examined up to 2 years...

Platelet and Fibrinogen Reactions in Pseudomonas aeruginosa Exotoxin Shock

The distribution of radioactively labelled platelets, fibrinogen and erythrocytes in blood and various organs was studied after one injection of Pseudomonas aeruginosa exotoxin in dogs. The blood pressure often immediately dropped but then rapidly returned to the control level. This so-called anaphylactoid phase was followed by a progressive shock accompanied by decreasing blood pressure. The platelets also immediately decreased in the blood and appeared in the lungs during this anaphylactoid phase. Immediately after the injection there were also signs of platelet aggregation in the blood. These changes had a tendency to return to the control-value levels but did not fully reach these levels again. No further changes were observed in the blood or lungs during the shock phase. The changes are interpreted as a platelet aggregation induced by the exotoxin. Evidence of a fibrinogen consumption was found but there was no accumulation in any organ. The changes were not induced by the surgical trauma which was necessary to obtain organ biopsies. A similar behaviour of platelets and fibrinogen in blood was found in dogs not subjected to thoracotomy or laparotomy.