Search

Objectives: The aims of this study were to describe the diagnosis of autoimmune pancreatitis (AIP) in Denmark and to test the usefulness of the International Consensus Diagnostic Criteria (ICDC) on a geographically well-defined cohort., Methods: All patients diagnosed with AIP at Odense University Hospital from 2007 to 2013 were included (n = 30; mean follow-up, 26.2 months). Data from laparoscopic or percutaneous ultrasound-guided core needle biopsy (CNB), resection specimens, endoscopic ultrasound (EUS), EUS-guided CNB, computed tomography, serum immunoglobulin G4 (IgG4), and pancreatography were retrospectively analyzed according to ICDC., Results: Twenty patients were diagnosed with type 1, 8 with type 2, and 2 with not otherwise specified AIP. Twenty-eight patients (93%) could correctly be classified when ICDC were retrospectively applied. Serum IgG4 was elevated in 44% of type 1 and 0% of type 2. Other organ involvement was observed in 40% of type 1 and 13% of type 2, but inflammatory bowel disease only in type 2 (P = 0.001). One patient had IgG4-related chronic perisplenitis as a hitherto undescribed manifestation of IgG4-related disease. Nineteen (91%) of 21 biopsied patients had diagnostic CNB features of AIP. Computed tomography, EUS, and pancreatography showed features highly suggestive or supportive of AIP in 68%, 72%, and 71%, respectively., Conclusions: Laparoscopic or percutaneous ultrasound-guided CNB had the highest sensitivity for AIP. The ICDC could retrospectively correctly diagnose 93% of the patients.

Local treatment of non-resectable liver tumors is common. This brief review describes the local treatment techniques used in Denmark. The techniques are evaluated according to the evidence in literature. The primary local treatment is Radiofrequency Ablation of both primary liver tumors and liver metastasis. Radiofrequency treatment is based on case-control studies, but the impact of the treatment seems obvious. However, randomized controlled studies are necessary in the future in order to guide indications according to different stages of disease, techniques and treatment regimes.

Twenty percent of colorectal cancer patients present disease in both bowel and liver. Traditionally, bowel cancer was resected and patients then re-staged for liver resection. This brief review presents literature to evaluate the support for either synchronous or staged operation. No randomised controlled studies have been published, but recently published case control trials show that synchronous resection can be performed with low morbidity and mortality. The question of whether the synchronous procedure is better than the staged operation is a non-solved matter in literature.

Background and Study Aims: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP)., Patients and Methods: The test performance and potential clinical impact of EUS and MRCP, had each investigation been performed as the first examination method, were compared prospectively in 163 patients admitted for and examined by endoscopic retrograde cholangiopancreatography (ERCP)., Results: The accuracies of EUS and MRCP were 0.93 and 0.91, respectively (no significant difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially., Conclusions: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP workload was highly dependent on the presumed probability of needing endoscopic therapy.

Despite being a well-described diagnostic procedure for more than ten years, endoscopic ultrasonography (EUS) is not generally widespread in Denmark. This review deals with the present indications for EUS. For some diseases, EUS has found its precise place in the diagnostic strategy. However, in other diseases, it is not yet clear where to put EUS in relation to other diagnostic procedures.

The aim of this study was to evaluate the efficacy of steroid application in the treatment of childhood phimosis. In a consecutive study 91 boys were treated with application of topical betamethason 0.05% cream twice daily. The foreskin was treated for one month, with an attempt at foreskin retraction after fourteen days. Treatment was controlled after one month and six months. Sixty boys achieved full retraction of the foreskin and nine had partial retraction and relief of symptoms. Twenty-two boys had unsatisfactory response and had an operation. Forty-five boys were controlled after six months, 13 had recurrence, of these nine were satisfied and free of symptoms, two had a new steroid treatment with full success, and two wanted a circumcision. A total of 74% did not need an operation after topical steroid treatment. No side-effects or complications were registered. Childhood phimosis can be successfully treated with steroid application, and the treatment should be offered prior to an operation.

Objective: Vesicovaginal fistulae in the western world generally occur as complications to pelvic surgery or radiation therapy of pelvic cancers. We have reviewed our results of vesicovaginal fistula closure procedures over a 10-year period., Patients and Methods: From 1985 to 1996, 55 patients were referred to our department due to vesicovaginal fistulae. Five patients had fistulae due to malignant recurrence and one patient was considered inoperable. Thus, 49 patients were operated on. Thirty patients had fistulae resulting from pelvic surgery. Nineteen of the 25 patients admitted with fistulae secondary to radiation therapy of pelvic cancers were operated on., Results: Of the 30 patients with postoperative fistulae, 23 had an abdominal repair and 7 a vaginal repair. A success rate of 90% was achieved after a first closure procedure, as 3 patients within a month experienced a recurrence. These three recurrences were all successfully closed in a second operation, augmenting the success rate to 100% in this group of patients. In the group of patients with fistulae caused by irradiation, a urinary diversion was performed in 12 patients, and in 7 patients a primary attempt to close the fistula was made, either by an abdominal approach (2 patients) or by a vaginal approach (5 patients). The fistula recurred in 6 of these 7 patients. Despite several additional attempts to close the recurrent fistulae, only one patient was successfully operated on., Conclusion: It seems that vesicovaginal fistulae resulting from pelvic surgery, in our hands, can be managed successfully either by an abdominal or vaginal approach. For patients with vesicovaginal fistulae resulting from radiation therapy, a urinary diversion appears to be the method of choice.

Two case stories of abdominal actinomycosis are described. Knowledge and proper treatment of this bacterial disease are important in order to prevent recurrent abscesses or major surgical operations.

Objective: To describe our experience with a cuffed oesophageal prosthesis in the management of malignant oesophagoairway fistulas., Design: Retrospective study., Setting: Teaching hospital, Denmark., Subjects: Nine patients treated with a balloon cuffed oesophageal prosthesis during the period 1987-93., Main Outcome Measures: Endoscopic assessment of the fistula compared with the results and complications of treatment., Results: The prosthesis were inserted without complications. Eight patients had total relief of aspiration and were able to eat a semisolid diet. Three patients needed reintervention. Patients with little or no stenosis of the tumour seemed to be at considerable risk of dislodgement of the tube and those with large fistulas developed protrusion of the balloon into the tracheal lumen., Conclusion: Intubation with the cuffed oesophageal prosthesis is safe and relatively inexpensive. Other treatments should be considered in patients with minor stenosis of the tumour or a large fistula.

During the period 1984-1991, out-patient control of 75 pregnancies of diabetic women or women who developed diabetes during their pregnancy was performed. The controls were arranged prospectively so as to investigate the patients' metabolic status in relation to malformations and the perinatal mortality. The frequency of malformations was calculated as 8% and the perinatal mortality as 6.6%. The results show that the patients began the controls at a quite advanced stage of their pregnancies and that very few were well-regulated prior to conception (6%). Under out-patient control, the patients achieved an improvement in their metabolic status which is comparable to that of other centres. It is concluded: 1) That there is a need for optimal metabolic status before conception which requires special treatment of the group of fertile diabetic women and 2) that controls can be performed under an out-patient regime.

A case of a pancreatic somatostatinoma in a 54 year old male is presented. A pancreatic carcinoma with hepatic metastases were primary diagnosed, and the patient had a palliative choledochoduodenostomy and gastroenteroanastomosis. As he was still alive four years later, the histological samples were reevaluated. Immunohistochemically the tumor was found positive for somatostatin, neuron-specific enolase and pancreatic polypeptide. Symptoms, diagnosis, pathology and treatment in relation to somatostatinomas are discussed.

A consecutive series of 32 repairs of massive incisional hernias have been followed up for a median of 45 months (range 8 months to 11 years). The reconstruction was based on the frontal leaf of the rectus abdominis and insertion of free fascia or pedicle flap from the tensor fascia lata muscle combined with transposition of the rectus muscle. Median size of the hernias was 20 x 17 cm (range 6-35 x 8-30). The incidence of risk factors for both recurrence as well as operative complications was high. During the median observation period of 45 months 9 hernias recurred, the main benefit of a successful reconstruction was relief of pain in the abdominal wall and the lower back. We conclude that the method is useful for the treatment of patients with large ventral hernias. Reduction of controllable recurrence risk factors is important, and the treatment requires substantial resources and expertise.