The risk of developing rectal cancer after colectomy and ileorectal anastomosis in Danish patients with polyposis coli

Fifty-eight Danish polyposis patients had been treated with colectomy and ileorectal anastomosis by the end of 1982. Three of these patients developed rectal cancer despite regular proctoscopic control, but one was probably an overlooked synchronous cancer. The cumulative risk at five and ten years after operation (actuarial method) was 3.5 and 13.3 per cent (95 per cent confidence limits 0-10.3 and 0-70.3 per cent, respectively), which seem to be acceptably low figures. This study supports the assumption that colectomy and ileorectal anastomosis is still the operation of choice in polyposis patients without rectal cancer.

The Danish Polyposis Register. Description of the methods of detection and evaluation of completeness

A manual Danish register of patients with familial polyposis coli and their family members was established in 1971. The methods of collection of propositi, preparation of pedigrees, collection of call-up cases, and the organization of the register are described. A country-wide prophylactic proctosigmoidoscopic examination of first-degree relatives, aged 10 to 59 years, resulted in the detection of 42 call-up cases and by December 1982, 319 cases of polyposis were registered in 94 families. An evaluation of the number of collected propositi and call-up cases shows almost complete registration.

Mandibular osteomas in familial polyposis coli

Orthopantomograms of the mandible were performed on 46 patients with familial polyposis coli having no clinical signs of Gardner's syndrome and on 46 control patients matched according to age and sex. Thirty-five patients (76.1 per cent) and two (4.3 per cent) controls had osteomas (P less than 0.0005). It is concluded that orthopantomography of the mandible is a valuable diagnostic supplement to prophylactic proctosigmoidoscopic examination of first-degree relatives of polyposis patients. Due to the frequent occurrence of mandibular osteomas in polyposis patients without clinically detectable extracolonic manifestations, it is suggested that "Gardner's syndrome" is no longer considered a clinical entity.

Hereditary colon cancer syndromes: an in vitro study

Assays of in vitro biological properties associated with cellular transformation revealed differences in cultured skin cells within the heritable colon cancer syndromes with and without polyposis coli. Such evidence suggested that an in vitro panel of biological assays could be used to recognize genotypes which increase the risk of colon cancer prior to clinical expression and supported the concept, long assumed on clinical differences, of genetic heterogeneity within the heritable colon cancer syndromes.

Colorectal cancer in patients less than 40 years of age in Denmark, 1943-1967

A retrospective review of all the 951 patients less than 40 years of age with colorectal cancer in Denmark 1943-67 is described. The annual incidence in Denmark of colorectal cancer in this age group is 1.4/100,000. These patients do not differ from other patients with colorectal cancer with regard to sex ratio, tumor localization, extent of tumor growth, histologic type, frequency of intestinal obstruction and perforation. Of these patients 53 per cent were subjected to radical operation. The five-year crude survival rate was 32 per cent for all patients and 65 per cent in cases of radical operation. The operative mortality was 9 per cent. The extent of tumor growth according to Dukes' classification and the presence of intestinal obstruction and/or perforation were the only factors found to influence the prognosis. The survival rates correspond to rate given in the literature in respect of colorectal cancer, regardless of age. It is concluded that colorectal cancer in young patients differs in no respect from the disease in older patients.

A randomized double-blind trial of glucagon in treatment of first attack of severe acute pancreatitis without associated biliary disease

The effects of glucagon versus placebo were evaluated in a double-blind trial including only patients with a first attack of severe acute pancreatitis not associated with biliary disease. All 22 patients had deterioriation of their clinical condition, elevated serum amylase and pulse rate above 100/min. or shock. An initial dose of 1 mg. glucagon was given as a bolus injection followed by infusion of 6 mg. in 1,500 ml. saline/24 hr. for three days. All were treated with nasogastric decompression, fluids, calcium and antibiotics. Severe complications developed in five of the 10 patients receiving glucagon and in eight of the 12 given a placebo. Three of the 10 (glucagon) and five of the 12 (placebo) died from these complications. Hemorrhagic pancreatitis was found in 11 patients at laparotomy or autopsy. Three of the five with hemorrhagic pancreatitis in the glucagon group and four of the six in the placebo group died. Pooling the data of the present and two other studies makes it probable that glucagon has no effect on mortality from acute severe pancreatitis.

Cimetidine for severe gastroduodenal haemorrhage: a randomized controlled trial

During a period of 12 months, 88 patients with severe haemorrhage from gastric or duodenal ulcers or from erosive gastritis completed a double-blind trial of either cimetidine or placebo. Only patients needing immediate blood transfusion were admitted to the trial. It was found that in patients with severe bleeding from gastric or duodenal ulcers neither the severity of bleeding nor the incidence of emergency surgery was reduced by cimetidine. Furthermore, the treatment did not improve the mortality rate. It is concluded that patients with severe bleeding from gastric or duodenal ulcers will not benefit from immediate treatment with intravenous cimetidine.

Reappraisal of surgery for suppurative cholecystitis

Ninety-two patients with suppurative cholecystitis operated on as emergency cases were studied in retrospection. Obstructive cholangitis was seen in two, who eventually died. The mortality after cholecystectomy alone was related to the presence of stones in the common bile duct. The mortality after cholecystostomy alone was related to shock and septicemia, but not to the presence of common bile duct stones or obstructive cholangitis. It was concluded that suppurative cholecystitis with accompanying common bile duct stones should be treated with cholecystectomy and choledocholithotomy, because of the lower rate of reoperations and possibly lower mortality than after cholecystectomy alone; an exception should be made in patients with deterioration in clinical condition or patients in whom technical difficulties develop during the operation. These patients should be subjected to a cholecystostomy as the only emergency procedure.

The incidence of male hermaphroditism in girls with inguinal hernia

The incidence of male hermaphroditism in girls with inguinal hernias is estimated to be 1.4 per cent. From 1961 to 1972, 340 girls were admitted to the Department of Surgery at St. Josephs Hospital for hernial repair. One hundred and two patients had menstruated prior to the follow-up study. Buccal smears from the remaining patients were examined for Y chromatin-positive cells. We observed a zero per cent rate of male hermaphroditism, which is not significantly different from the aforementioned frequency, p greater than 0.05. Large scale prospective studies must be available before any conclusion can be drawn as to whether or not determination of the genetic gender prior to hernial repair in girls should be conducted as a routine procedure.