BACKGROUND AND STUDY AIMS:The aim of the present study was to analyze the reasons for false findings on computed-tomographic (CT) colonography.PATIENTS AND METHODS:A total of 100 consecutive CT colonography examinations were carried out before conventional colonoscopies scheduled on the same day. Before the study, an experienced radiologist received training in analyzing CT colonographies. The radiologists and endoscopists were blinded to each others' findings. The patients received standard polyethylene glycol bowel preparation and were scanned in the prone and supine positions using a helical CT scanner and commercially available software for image analysis. Each pair of examinations was later followed by an unblinded analysis, comparing the CT colonographies with video recordings of the conventional colonographies in order to determine the reasons for tumors being missed or false-positive diagnoses arising on CT colonography.RESULTS:Ninety polyps were detected in 41 patients. For patients with tumors > or = 5 mm and > or = 10 mm, the sensitivity was 67 % and 75 %, respectively, and the specificity was 84 % and 95 %, respectively. The most important reasons for the 38 false findings of tumors > or = 5 mm were perception errors (21 of 38) and misinterpretation of flat lesions in particular, including a high-grade dysplasia and a flat elevated Dukes A carcinoma. Residual stool was frequently the reason for misinterpreting lesions > or = 10 mm (four of 10).CONCLUSIONS:Perception errors were the main reason for false findings of lesions > or = 5 mm, including one flat malignant lesion. Residual stool caused four of 10 false findings for lesions > or = 10 mm. Reading CT colonographies requires a high level of expertise, and conventional colonography is still regarded as the gold standard for detecting colorectal lesions.

Background: During the first eight years of laparoscopic cholecystectomy, a voluntary registration with participation of all 58 departments in Denmark offering this procedure has been carried out (Gastrointest Endoscopy; 48: 332-4), with main objectives being quality assurance on local and national level, and outcomes research including safety issues. Registration is ongoing. The value of clinical databases like this depends on several factors, of which accuracy and completeness are of critical importance. Aims: To validate completeness and accuracy of registry data reported from three randomly chosen departments to The Danish National Registry of Laparoscopic Cholecystectomy. Methods: The contents of all consecutive case reports comprising all laparoscopic cholecystectomies performed over two years in three randomly chosen surgical departments were compared with data reported to the registry. Discrepancies were identified, and complication rates in non-reported (missing) cases were compared with rates in reported cases. Results: 431 of 509 eligible patients had been reported to the registry. Completeness of reporting from the three departments were 69%, 80% and 95%, respectively, significantly higher in the single department with a formalised registration and reporting procedure. Eight filled forms were found in the case notes (all from the same department), and another 8 patients with inaccessible case notes were excluded from the validation. Inaccuracies were noted in 28%, 41% and 51% of the cases, but none regarding serious complications such as bile duct injury or perioperative death. Complication rates or length of stay did not differ between reported and missing cases. The most frequently occurring inaccuracies regarded the indications for surgery (in 6%, 11% and 17% in the respective departments) and the date of discharge (in 1%, 7% and 6%) Conclusion: The information on serious complications in the registry may be accurate provided that the present findings can be extrapolated to all participating departments, but the overall accuracy should be improved. A formalised procedure of handling and forwarding information to the registry is necessary to ensure completeness. Continuous validation, support and motivation to the contributing departments by means of, e.g., visits by registry staff for direct validation with case notes may increase costs, but would result in a higher accuracy and complete registration, and should be accounted for in funding.

The aims of the study are to analyse Swedish trends in overweight and obesity–as measured by body mass index (BMI)–between 1971 and 1995, and to examine socioeconomic and geographic differences between groups of individuals on the basis of information on 18‐y‐old military conscripts. The study population comprises all males born in 1953, 1958, 1963, 1968, and between 1973 and 1977, reported to be living in Sweden at 17 y of age according to nationwide population registers (RTPs). Utilizing the unique personal ID number, sociodemographic data in the RTPs and in Population and Housing censuses were linked to data on BMI in the national Military Service Conscription Registry for the years 1971 to 1995. These data were obtained from compulsory medical examinations held at military induction at 18 y of age. BMI data were available for 448 732 (89%) of a total of 503 689 subjects. Mean BMI increased by 6.6% over the study period–from 21.1 kg/m 2 in 1971 to 22.4 kg/m 2 in 1995. Unadjusted trend analyses showed a 2.4 times increase in the prevalence of overweight among 18‐y‐old males over the period–from 6.9% in 1971 to 16.3% in 1995. Over the same years, the prevalence of obesity increased 3.5 times– from 0.9% to 3.2%. After adjustment for muscle power, demographic factors, and living area, the prevalence of overweight was found to have increased 1.4 times, and obesity 1.7 times between 1971 and 1993. The prevalence of overweight was considerably higher among 18‐y‐old males from low‐educated families than among those from high‐educated families in both 1971 and 1995. The prevalence of overweight was also found to be higher in both 1971 and 1995 among young men from rural and/or sparsely populated areas than among those living in Sweden's largest cities. Mean BMI, and the prevalence of overweight and obesity have increased among 18‐y‐old males in Sweden over the last 24 y. The increased risk of overweight among young men from low‐educated families and those from rural and/or sparsely populated areas detected in 1971 was still evident in 1995.

BACKGROUND: The risk of bile duct injury in laparoscopic cholecystectomy has been a concern since the procedure became part of the surgical armamentarium. Our study assesses the incidence, types, and treatment for laparoscopic bile duct injury.STUDY DESIGN: Prospective case registration in a national database with participation by all departments of surgery performing laparoscopic cholecystectomy in Denmark since the first operation in January 1991. The case notes for bile duct injury have been reviewed.RESULTS: From 1991 through 1994, 57 of 7,654 patients sustained bile duct injury (0.74 percent; 95 percent confidence interval, 0.55 percent to 0.94 percent), including nine injuries occurring after conversion. The annual incidence did not decrease. Thirty-nine percent of the laparoscopic bile duct injuries were incisions, 39 percent were transections, and 12 percent were clip injuries or strictures. One patient, who sustained transection during open reoperation for bleeding after a converted procedure, died. Bile leaks for reasons other than bile duct injury occurred in 2.1 percent; 71 percent of these were cystic duct leaks. Acute cholecystitis was the indication for laparoscopic cholecystectomy in 968 patients, with 1.3 percent sustaining laparoscopic bile duct injury (95 percent confidence interval, 0.62 percent to 2.08 percent), while the incidence in patients with other indications for laparoscopic cholecystectomy was 0.62 percent (95 percent confidence interval, 0.44 percent to 0.82 percent) (p>0.05). Preoperative knowledge of bile duct anatomy was available by means of preoperative endoscopic retrograde cholangiopancreatography or intravenous cholangiography in 26 percent of patients undergoing laparoscopic cholecystectomy but this did not reduce the risk of bile duct injury. The frequency of bile duct injury in patients who had intraoperative cholangiography was not significantly different from those who did not. Intraoperative cholangiography was done in 14 cases of injury (diagnostic for injury in 8, misinterpreted in 2, and normal in 4 patients), The case notes described operative difficulties in 11 of 48 cases of laparoscopic bile duct injury, most often because of fibrosis or difficulty delineating the anatomy.CONCLUSIONS: The incidence of bile duct injury in laparoscopic cholecystectomy is higher than previously generally anticipated and did not decrease from 1991 through 1994. Risk factors and possible preventive measures should be evaluated in prospective studies.

Laparoscopic cholecystectomy (LC) was introduced in Denmark in 1991, and a prospective case register was established. All departments performing LC agreed to participate. In 1991-1992, 2,415 patients underwent LC in 44 departments. The median number of procedures was 32 (interquartile range 18-58, range 1-370), performed by a median of four surgeons per department (3-5, 1-23). Two hundred and forty-two patients (10%) had acute cholecystitis. Eighteen point five percent had had an ERCP performed prior to LC. The rate of conversion to open operation was 10.5%, occurring significantly more often in acute cholecystitis (25.6%) than in patients with other indications (8.8%) (p < 0.001). Intraoperative cholangiography was used in 22.4%. The median duration of LC was 90 minutes (70-120, 25-415). The postoperative course was without complications in 90.4%. Laparotomy for complications was necessary in 43 patients (2.0%), mainly because of bile leaks. Twelve patients (0.6%) were treated endoscopically for complications. Bile duct injury occurred in 16 patients (0.66%, 95% CI 0.34-0.99%), including three transsections, one stricture, and 12 minor injuries. Six patients (0.25%, 95% CI 0-0.45%), three of whom had procedure-related complications, died postoperatively. All were > or = 72 years of age. Median time to discharge was two days, while median time to resumed work/normal activity was eight days. A comparison with the number of LC registered in the National Patient Register indicates that reporting is complete.

OBJECTIVES:To describe initial experience with a new technique for obtaining lung biopsy specimens using video-thoracoscopy and Multifire Endo GIA (U.S. Surgical Corporation) stapler.DESIGN:Retrospective study.SETTING:Central hospital, Denmark.SUBJECTS:Nine patients with suspected pulmonary fibrosis.MAIN OUTCOME MEASURES:Diagnosis, morbidity, and mortality.RESULTS:The endoscopic method provided a specimen of lung tissue large enough to secure a reliable diagnosis in all cases.CONCLUSION:The thoracoscopic technique implies less surgical trauma than thoracotomy resulting in less postoperative pain and a better cosmetic result. In patients suitable for general anaesthesia the endoscopic method for obtaining lung tissue specimen seems to be the ideal method.

OBJECTIVE To compare three doses of cefotaxime alone with a single dose of cefotaxime and metronidazole for the prophylaxis of infection after elective colorectal operations. DESIGN Prospective random control trial. SETTING Hillerød and Frederiksberg Hospitals, Copenhagen, Denmark. SUBJECTS 660 consecutive patients who were to undergo elective colorectal operations during a 48 month period (January 1987-January 1991); 93 (14%) were withdrawn after randomisation leaving 567 for assessment. INTERVENTIONS Mechanical bowel preparation, and then either cefotaxime (Claforan) 2 g intravenously at induction of anaestesia and 3 and 9 hours later (n = 280) or a single dose of cefotaxime 2 g plus metronidazole (Flagyl) 1.5 g intravenously at induction of anaestesia (n = 287). RESULTS 44 patients in the cefotaxime group developed wound infection (16%) compared with 19 (7%) in the combined group (p < 0.001). In the cefotaxime group 22 of the 241 patients who had an anastomosis developed leaks (9%) compared with 8 of the 239 in the cefotaxime/metronidazole group (3%). There were no differences in the incidence of intra-abdominal abscesses or burst abdomens. The most common organisms isolated from wounds were Escherichia coli and Bacteriodes fragilis. CONCLUSION One dose of cefotaxime and metronidazole is active against a wide range of organisms and resulted in significantly fewer wound infections than three doses of cefotaxime alone.

In 1987, Mouret devised a technique of performing cholecystectomy through a laparoscope. When performed correctly and on the right indications, this type of minimal invasive surgery has distinct advantages for the patients. Postoperative hospitalization is reduced to a few days and most of the patients can return to work or normal activities within a week or two. In this department, laparoscopic cholecystectomy was used for treatment of symptomatic gallbladder stones in 34 patients. In three patients the procedure was converted to an open laparotomy. No mortality and no ductal injuries were observed and no re-operations were necessary. The operating time averaged 102 minutes and the postoperative stay was 2.3 days. The average duration of sick-leave was 12 days. We are convinced, that this new technique will play a dominant role in the future treatment of symptomatic cholelithiasis.

In vitro tetraploidy (IVT) in cultures of skin fibroblasts was compared with tumor DNA ploidy, as determined by flow cytometry on paraffin-embedded material, in 99 patients with colorectal neoplasm. In 63 patients with non-heritable carcinoma we found a significant correlation between the number of aneuploid stemlines in the tumor and IVT in the fibroblast culture. Furthermore, tumor aneuploidy was significantly correlated to the size of the tetraploid subpopulation in the fibroblasts. There was no correlation between aneuploidy and Dukes's stage or the degree of differentiation. In 36 patients with adenoma no correlation between tumor aneuploidy and fibroblast IVT was demonstrated, whereas the number of tumor stemlines was significantly correlated to histopathologic stage and grade of dysplasia. IVT in cultured skin fibroblasts, which has been reported to reflect a genetic predisposition to colorectal cancer in heritable colon cancer syndromes, thus seems to be relevant also for the understanding of tumor formation and progression in the 'non-heritable' type of colorectal cancer.

Whether or not topical application of ampicillin is necessary in patients undergoing elective colorectal operations was investigated. After mechanical preparation, 193 patients received 2 grams of cefotaxime administered intravenously from the start of the operation; patients received two more doses within the next 12 hours. In addition, patients were randomized to receive or not receive prophylaxis against infection of 2 grams of ampicillin in the site of the incision at closure. Twenty-three patients did not complete the study. Wound infection occurred in five of 81 patients who had topical application of ampicillin compared with six of 89 patients who did not receive prophylaxis; the difference was not significant. There were no significant differences in rates of wound dehiscence, intra-abdominal abscess or anastomotic leakage. Escherichia coli and Bacteroides fragilis were the predominant microorganisms isolated. Thus, topical application of ampicillin did not lower the wound infection rate when there was a preoperative antibiotic administered intravenously.

The nuclear DNA content in 67 prostatic carcinomas was measured by flow cytometry of nuclear suspensions prepared from paraffin-embedded tissue blocks. A method was developed that provided nuclear suspensions of good quality whether tissue blocks from transurethral resections or transvesical prostatectomies were used. Thirty (43.7%) of the tumors were found to be aneuploid. No significant correlation between clinical stage or histological grade and aneuploidy was demonstrated.

A national Danish series of 68 breast sarcomas from 66 women and one man (age 17-86 years) was investigated. Tumour sections from 22 stromal sarcomas (SS), 24 phyllodes tumors of malignant type (MCSP), seven phyllodes tumors of borderline type (BLCSP), four malignant fibrous histocytomas (MFH), eight liposarcomas, two angiosarcomas and one leiomyosarcoma were reviewed retrospectively, and all patients were traced with a minimum follow-up of 15 years. Tumor contours appeared to be the best prognostic factor in predicting the risk of metastatic spread. Stromal overgrowth of MCSP was considered less utilizable due to difficulties in distinguishing between MCSP with marked stromal overgrowth and SS, which we consider as a variety of MCSP and which only showed slightly increased death rates compared to MCSP (45% versus 38%). Both angiosarcomas and the leiomyosarcoma proved lethal, and the other sarcoma subtypes had a death frequency of about 50%, with the exception of BLCSP, neither of which proved lethal. All patients, who died from metastases, were dead within 5 years irrespective of treatment. No positive lymph nodes were identified at the time of primary treatment, supporting the findings of previous investigators. We therefore advocate simple mastectomy or local excision with a wide margin as sufficient treatment of breast sarcomas. The indications for adjuvant therapy is as yet unclarified.