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Objective: To study the feasibility of percutaneous cryoablation of hepatic tumours monitored by magnetic resonance imaging (MRI). Design: Prospective study Setting: University hospital, Norway Patients: Six patients with hepatic metastases from colorectal cancer. Interventions: Percutaneous cryoprobe positioning under general anaesthesia. Positioning and freezing monitored by near-real-time MRI using an open 0.5 Tesla MRI configuration system. Main outcome measures: Safety and feasibility of the procedure. Measurement of volumes of cryolesions. Results: One patient developed a biliary leakage that had to be drained. Four patients developed pleural fluid. Two small tumours were adequately cryoablated. In the remaining 4 patients with large (> 4 cm) tumours, an adequate cryolesion could not be formed. Cryolesion volumes larger than 105 cm[sup 3] were not produced even using 3-4 probes. MRI visualised the growing cryolesion well, but positioning of the cryoprobes was time-consuming. Conclusion: MR guided cryoablation is clinically feasible and gives good visualisation of the procedure. Patients with small tumours (< 3 cm) seem to be best suited to this percutaneous approach as cryolesion volumes claimed to be adequate for tumour destruction can be produced. Measurement of tumour volume preoperatively may help to select patients who will respond. [ABSTRACT FROM AUTHOR]

Presents an obituary for professor Egil Gjone, one of the three founding editors of 'Scandinavian Journal of Gastroenterology, who died on November 24, 1999 in Oslo, Norway.

Objectives: The main objective of this study was to investigate the characteristics of patients receiving private community physiotherapy (PT) the first year after a hip fracture. Second, to determine whether utilisation of PT could improve health-related quality of life (HRQoL)., Methods: In an observational cohort study, 30 752 hip fractures from the Norwegian Hip Fracture Register were linked with data from Statistics Norway and the Norwegian Control and Payment of Health Reimbursements Database. Association between covariates and utilisation of PT in the first year after fracture, the association between covariates and EQ-5D index score and the probability of experiencing 'no problems' in the five dimensions of the EQ-5D were assessed with multiple logistic regression models., Results: Median age was 81 years, and 68.4% were females. Most patients with hip fracture (57.7%) were classified as American Society of Anesthesiologists classes 3-5, lived alone (52.4%), and had a low or medium level of education (85.7%). In the first year after injury, 10 838 of 30 752 patients with hip fracture (35.2%) received PT. Lower socioeconomic status (measured by income and level of education), male sex, increasing comorbidity, presence of cognitive impairment and increasing age led to a lower probability of receiving postoperative PT. Among those who used PT, EQ-5D index score was 0.061 points (p<0.001) higher than those who did not. Correspondingly, the probability of having 'no problems' in three of the five dimensions of EQ-5D was greater., Conclusions: A minority of the patients with hip fracture had access to private PT the first year after injury. This may indicate a shortcoming in the provision of beneficial post-surgery rehabilitative care reducing post-treatment HRQoL. The findings underscore the need for healthcare policies that address disparities in PT access, particularly for elderly patients, those with comorbidities and reduced health, and those with lower socioeconomic status., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study was designed to examine the outcome of cancer of the lower rectum, particularly the rates of local recurrence and survival for tumors located in this area that have been treated by anterior or abdominoperineal resections., Methods: A prospective, observational, national, cohort study which is part of the Norwegian Rectal Cancer Project. The present cohort includes all patients undergoing total mesorectal excision in 47 hospitals during the period November 1993 to December 1999. A total of 2,136 patients with rectal cancer within 12 cm of the anal verge were analyzed; there were 1,315 (62 percent) anterior resections and 821 (38 percent) abdominoperineal resections. The lower edge of the tumor was located 0 to 5 cm from the anal verge in 791 patients, 6 to 8 cm in 558 patients, and 9 to 12 cm in 787 patients. According to the TNM classification, there were 33 percent Stage I, 35 percent Stage II, and 32 percent Stage III., Results: Univariate analyses: The five-year local recurrence rate was 15 percent in the lower level, 13 percent in the intermediate level, and 9 percent in the upper level (P=0.014). It was 10 percent local recurrence after anterior resection and 15 percent after abdominoperineal resection (P=0.008). The five-year survival rate was 59 percent in the lower level, 62 percent in the intermediate level, and 69 percent in the upper level (P<0.001), respectively, and it was 68 percent in the anterior-resection group and 55 percent in the abdominoperineal-resection group (P<0.001). Multivariate analyses: The level of the tumor influenced the risk of local recurrence (hazard ratio, 1.8; 95 percent confidence interval, 1.1-2.3), but the operative procedure, anterior resection vs. abdominoperineal resection, did not (hazard ratio, 1.2; 95 percent confidence interval, 0.7-1.8). On the contrary, operative procedure influenced survival (hazard ratio, 1.3; 95 percent confidence interval, 1-1.6), but tumor level did not (hazard ratio, 1.1; 95 percent confidence interval, 0.9-1.5). In addition to patient and tumor characteristics (T4 tumors), intraoperative bowel perforation and tumor involvement of the circumferential margin were identified as significant prognostic factors, which were more common in the lower rectum, explaining the inferior prognosis for tumors in this region., Conclusions: T4 tumors, R1 resections, and/or intraoperative perforation of the tumor or bowel wall are main features of low rectal cancers, causing inferior oncologic outcomes for tumors in this area. If surgery is optimized, preventing intraoperative perforation and involvement of the circumferential resection margin, the prognosis for cancers of the lower rectum seems not to be inherently different from that for tumors at higher levels. In that case, the level of the tumor or the type of resection will not be indicators for selecting patients for radiotherapy.

Introduction: Rectal cancer surgery has been characterized by a high incidence of local recurrence, an occurrence which influences survival negatively. In Norway there was a growing recognition that local recurrence rates were related to surgeon performance and that surgeons applying a standardized surgical technique in the form of total mesorectal excision could achieve better results. This contrasts with the prevailing argument voiced by many opinion leaders that local recurrence rates and possibly survival rates can only be improved by adjuvant or neoadjuvant treatment strategies. The Norwegian Rectal Cancer Project-initiated in 1993-aimed at improving the outcome of patients with rectal cancer by implementing total mesorectal excision as the standard rectal resection technique., Methods: This observational national cohort study covers all new patients (3,319) with rectal cancer from a population of 4.5 million treated between November 1993 and August 1997. The main outcome measures were local recurrence, survival, and postoperative mortality and morbidity rates. The technique of total mesorectal excision was compared with conventional surgery., Results: The proportion of patients undergoing total mesorectal excision was 78 percent in 1994, increasing to 92 percent in 1997. The observed local recurrence rate for patients undergoing a curative resection was 6 percent in the group treated by total mesorectal excision and 12 percent in the conventional surgery group. Four-year survival rate was 73 percent after total mesorectal excision and 60 percent after conventional surgery. Postoperative mortality rate was 3 percent and the anastomotic dehiscence rate was 10 percent. Radiotherapy was given to 5 percent and chemotherapy to 3 percent of the patients in the curative resection group., Conclusion: A refinement of the surgical resection technique for rectal cancer can be achieved on a national level, the technique of total mesorectal excision can be widely distributed, and surgery alone can give good results.

In Norway, a National Insurance Board decides whether patients treated abroad should have their expenses reimbursed. Its decisions may be appealed to an independent governmental board of appeals. This article presents the appeals procedure and discusses the experience gained over its first three years. The most important criterion for reimbursement is whether there is a lack of expertise in Norway on the relevant condition, which must be severe. A statement must be sought from a tertiary-level hospital about the proposed intervention. A referral or recommendation is not required. Reimbursement will not be considered for interventions defined as experimental, except in conditions that are so rare that the number of patients in Norway will be so small that one cannot expect large-scale randomised trials organised in this country. During its first three years, the board of appeals considered 184 cases; decisions were revered in 21 cases (11%). The appeals procedure remains well known among the public. Doctors should make themselves familiar with the criteria and the appeals procedure.

Background/aims: To study the characteristics and outcome of patients with hepatocellular carcinoma in a low-incidence region., Methods: 98 patients with hepatocellular carcinoma who had been referred to the Surgical Department, National Hospital, Oslo, between 1981 and 1999 were studied retrospectively. Tumour size, prevalence of cirrhosis, serum alpha-fetoprotein concentration, rate of resection, type of resection and survival were analysed., Results: 19% (19/98) of the patients had cirrhosis of varying aetiology. Median tumour size was 10 cm. alpha-Fetoprotein was normal in 46% of the patients. Hepatic resection was performed in 30 (31%) patients and 77% of the resections were major (more than 2 segments). Abdominal exploration was done in 33 patients and liver transplantation in 6 patients. No surgical intervention was made in 31 patients. Five-year actuarial survival in resected patients was 24%. Median survival of non-resected patients was 3.3 months., Conclusion: The patient characteristics in this study differ from patient cohorts with hepatocellular carcinoma in other geographical areas. The main differences are large tumour size, low prevalence of the disease, and diverse aetiology of cirrhosis., (Copyright 2002 S. Karger AG, Basel)