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Introduction: Transanal endoscopic microsurgery (TEM) was developed by Gerhard Buess in 1983 as an alternative to traditional transanal surgery. The method has become more and more widespread in the treatment of benign as well as T1 rectum tumours. We have used the method for several years and we present our results in this paper., Materials and Methods: Retrospective examination of patient files from consecutive registered patients who underwent TEM in the period June 1999 to November 2004, in all 76 operations on 74 patients., Results: 49 patients had adenomas; both the recurrence and complication rate was 6%. Median follow-up period was 12 months (range 0-57). 15 had a T1 tumour removed; the recurrence rate was 15%. One had a serious complication. Median follow-up period was 12 months (range 3-36). Eight had a T2 tumour removed; the recurrence rate was 16%. One had a serious complication. Median follow-up period was 21 months (range 9-36). Two patients were treated for a T3 tumour as part of palliation., Conclusion: Our results are comparative to the largest foreign data. The recurrence rate is on the same level as open as well as laparoscopic surgery and far less than traditional transanal surgery. The complication risks are on the same level as laparoscopic access and far less than open surgery. However, preoperative investigation has to be developed further. Research is needed to clarify if selected patients with T2 cancer could be treated with TEM in combination with radiotherapy.

Introduction: Only two out of three Danish women follow the recommendations for duration of breast-feeding given by The Danish National Board of Health, which recommend it as the sole source of nutrition for at least the first four months of life. The present study was carried out to investigate the influence of patient satisfaction on the duration of breast-feeding., Material and Methods: Based on an earlier investigation into the satisfaction of primiparas with the public health service during pregnancy, delivery, and the puerperium, 145 women were interviewed by telephone about the period in which their child was fed solely by mother's milk. Mothers of twins and those who had had an elective caesarean or whose child had been transferred to the neonatal care unit were excluded. Data from the patient satisfaction study and data on the delivery retrieved from a local obstetric database were related to the duration of breast-feeding., Results: The mean duration of breast-feeding only was four months with no association to the women's satisfaction with the public health service in general. There was, however, an association between the period of breast-feeding only and satisfaction with issues dealing specifically with breast-feeding. In women who had had an oxytocin infusion breast-feeding was more often well-established. No other event during labour related to the initiation or duration of breast-feeding. There was an insignificant trend towards more use of a pacifier or formula supplementation in the first days in women, who did not initiate breast-feeding. It is unknown whether this is a cause or a consequence., Discussion: The initiation of breast-feeding is influenced by the woman's satisfaction with the public service in matters relating to breastfeeding. In other ways, it is a process that is difficult to disturb.

Introduction: Over the past decade a number of studies on the incidence and preventability of adverse events in the health care have been published in the US, Australia and the UK. So far no similar study has been performed in Denmark. In order to determine whether foreign findings could be generalised to Danish health care, a pilot study on adverse events was carried out in Danish acute care hospitals., Method: Chart reviews were carried out on 1.097 acute care hospital admissions, sampled from the central Danish National Patient Register. The sample was truly proportional with no over-sampling of high-risks groups. Chart reviews was done in 17 different acute care hospitals, reviewing between 20 and 204 admissions per hospital. Adverse events was identified using a three-step procedure: 1) Nurse screening by 18 criteria identifying high-risk groups. 2) Independent reviews by pairs of consultants. 3) In case of disagreement between second step consultants, two additional independent reviews was performed by new consultants (internist and surgeon) followed by conference. All chart reviews were performed independent of medical specialty. All nurses and doctors were senior and experienced clinicians., Results: In 114 admissions 176 Adverse Events (AEs) were identified. The prevalence of admissions with adverse events were 9.0% of all admissions. Preventability of adverse events was found in 46 of admissions (40.4% of AEs). The adverse events caused on average a 7.0 days prolonged hospital stay. Most adverse events resulted in minor, transient disabilities. Permanent disability or death in relation to adverse event were recorded in 30 admissions., Discussion: The findings from the Danish Adverse Event Study are similar to the results found in Australia, United Kingdom and the United States. It is therefore recommended that further Danish research, is directed towards high-risk groups focussing on narratives and intervention and towards research in primary health care.

Aim: A description of technique, course and results of operation for left-sided obstruction of the colon with primary resection, perioperative lavage of the colon and primary anastomosis., Design: Retrospective examination of case records., Material: From January 1st 1994-December 31st 1997 eight operations were performed including primary resection, perioperative lavage and primary anastomosis., Results: No anastomotic leaks were found. One patient died five days postoperatively due to cardiac complications. Three patients had postoperative cardiopulmonary complications treated medically. One patient had rupture of the fascia, was reoperated, experienced wound infection, transient serum elevation of liver enzymes and underwent ERCP with papillotomy and extraction of stones from the common bile duct two months postoperatively., Conclusion: In this small series the technique has appeared safe, thus confirming previous reports.

Aim: A retrospective study of 69 cases of gastric cancer seen during the period from 1/1-1990 to 31/12-1994 treated in a University Hospital. The aim of the study was to describe morbidity, mortality and identify independent prognostic variables for mortality., Method: Patient data were recovered from the hospital's central database. Mortality was chosen as end-parameter. Univariate log-rank-test identified statistically significant variables which were then analysed by Cox backward stepwise regressional analysis., Material: Sixty-nine patients were available for analysis, median age 73 years. Fifty-one patients underwent operation. Eighteen patients did not have a surgical procedure due to disseminated disease. The overall postoperative morbidity was 25% and postoperative mortality 10%. The overall five-year survival rate was 8%, 12% for operated patients, 35% after radical and 0% after non-radical or omitted surgery. Age, radicality of operation, type of operation, Borrmann's tumour classification, and degree of depth of local infiltration were identified as significant factors for survival. Cox's analysis identified type of operation (p = 0.0002) and Borrmann's tumour classification (p = 0.001) as independent variables., Discussion: The overall five-year survival is low and has not changed over two decades in Denmark, whereas mortality and morbidity rates have improved. It should be recommended that: The treatment of gastric cancer must be centralised in order to develop preoperative examinations, operative technique and the necessary routine for the surgeons. All gastric ulcers must be considered malignant and biopsies taken accordingly.

The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.

We present a 33 year-old man with massive upper gastrointestinal bleeding caused by a rare form of segmental portal hypertension. The patient developed a pancreatic abscess, which caused an isolated thrombosis in the splenic vein and the development of pronounced collaterals and bleeding fundus varices. The patient underwent splenectomy and recovered quickly hereafter. The literature is sparse on severe bleeding complications due to acute pancreatitis. The present case emphasizes the importance of recognition of unusual manifestations of common clinical conditions.

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.

A 30-year-old woman, 35 weeks pregnant, developed spontaneous rupture of the oesophagus following severe vomiting, probably caused by treatment with Ritodrin (Utopar). The symptoms, diagnosis and treatment of spontaneous oesophageal rupture are discussed.

Colorectal cancer puts a major burden on the hospital resources because of its frequency and demands for extensive surgery. Screening with Hemoccult-II detects the disease at an earlier stage in a number of persons. The possible influence upon length of hospital stay is investigated in a randomised trial of 61,938 persons between 45 and 74 years, 30,970 being invited to screening with Hemoccult-II bianually. The first screening was accomplished in 20,672 persons and 17,284 have completed three screenings from 1985 to 1990. The test was positive in 1%, and further examination (colonoscopy) among these revealed cancer in 74 and adenomas in 248 persons. The whole screening group contained 239 persons with cancer and 380 with adenomas, the figures among controls being 216 and 181, respectively. The excess hospital stay in the screening group was 487 days (7%), the major part being one-day admissions for colonoscopy. The average stay was shorter in the screening group and shortest among those with colorectal neoplasia being detected because of positive Hemoccult-II. Measurements of hospital stay included admissions for diagnosis, treatment and complications as well as recurrence within the first year of diagnosis. In conclusion, the excess use of hospital days introduced by screening was limited in the first five years. This will probably later disappear and become negative because of decreasing numbers of cancers in the screening group. Advanced cancers and admissions for possible colorectal cancer will also be less frequent in the screening group.

The pH and faecal titratable acidity in fresh faeces were measured in patients with colo-rectal carcinoma or adenoma and in normal individuals. Significantly higher pH values and lower acidity were found in patients with cancer than in normal individuals. Patients with cancer had pH greater than 6.90 more frequently than normal. Patients with adenomata did not differ significantly from normal individuals. These results support performance of intervention trials with lowering of the pH in the colon with the object of cancer prophylaxis even although the causal connection is obscure.