Loberg M.,University of Oslo |
Loberg M.,Harvard University |
Kalager M.,University of Oslo |
Kalager M.,Telemark Hospital |
And 11 more authors.
New England Journal of Medicine | Year: 2014
BACKGROUND: Although colonoscopic surveillance of patients after removal of adenomas is widely promoted, little is known about colorectal-cancer mortality among these patients. METHODS: Using the linkage of the Cancer Registry and the Cause of Death Registry of Norway, we estimated colorectal-cancer mortality among patients who had undergone removal of colorectal adenomas during the period from 1993 through 2007. Patients were followed through 2011. We calculated standardized incidence-based mortality ratios (SMRs) using rates for the Norwegian population at large for comparison. Norwegian guidelines recommended colonoscopy after 10 years for patients with high-risk adenomas (adenomas with high-grade dysplasia, a villous component, or a size ≥10 mm) and after 5 years for patients with three or more adenomas; no surveillance was recommended for patients with low-risk adenomas. Polyp size and exact number were not available in the registry. We defined high-risk adenomas as multiple adenomas and adenomas with a villous component or high-grade dysplasia. RESULTS: We identified 40,826 patients who had had colorectal adenomas removed. During a median follow-up of 7.7 years (maximum, 19.0), 1273 patients were given a diagnosis of colorectal cancer. A total of 398 deaths from colorectal cancer were expected and 383 were observed, for an SMR of 0.96 (95% confidence interval [CI], 0.87 to 1.06) among patients who had had adenomas removed. Colorectal-cancer mortality was increased among patients with high-risk adenomas (expected deaths, 209; observed deaths, 242; SMR, 1.16; 95% CI, 1.02 to 1.31), but it was reduced among patients with low-risk adenomas (expected deaths, 189; observed deaths, 141; SMR, 0.75; 95% CI, 0.63 to 0.88). CONCLUSIONS: After a median of 7.7 years of follow-up, colorectal-cancer mortality was lower among patients who had had low-risk adenomas removed and moderately higher among those who had had high-risk adenomas removed, as compared with the general population. Copyright © 2014 Massachusetts Medical Society.
Bretthauer M.,University of Oslo |
Bretthauer M.,Sorlandet Hospital |
Bretthauer M.,Harvard University |
Kalager M.,University of Oslo |
And 2 more authors.
British Journal of Surgery | Year: 2013
Background: Cancer screening has the potential to prevent or reduce incidence and mortality of the target disease, but may also be harmful and have unwanted side-effects. Methods: This review explains the basic principles of cancer screening, common pitfalls in evaluation of effectiveness and harms of screening, and summarizes the evidence for effects and harms of the most commonly used cancer screening tools. Results: Cancer screening has either been established or is considered for breast, lung, prostate, cervical and colorectal cancer. In contrast, screening for gastrointestinal malignancies outside the large bowel is not generally accepted, available or implemented. Oesophageal and gastric carcinoma, and hepatocellular carcinoma, may be subject to screening in certain risk populations, but currently not for population screening based on available technology. Screening for colorectal cancer and cervical cancer by endoscopy and cytology respectively can decrease incidence of the target disease, whereas screening tools for lung, prostate and breast cancer detect early-stage invasive disease and thus do not decrease disease incidence. Overdiagnosis (detection of cancers that will not have become clinically apparent in the absence of screening) is a challenge in lung, prostate and breast cancer screening. The improvement of quality of clinical practice following the introduction of cancer screening programmes is an appreciated 'side-effect', but it is important to disentangle the effect of screening on cancer incidence and mortality from that of quality improvement of clinical services. As new, powerful screening tests emerge - particularly in molecular and genetic fields, but also in radiology and other clinical diagnostics-the basic requirements for screening evaluation and implementation must be borne in mind. Conclusion: Cancer screening has been established for several cancer forms in Europe. The potential for incidence and mortality reduction is good, but harms do exist that need to be addressed, and communicated to the public. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Heldal K.,Telemark Hospital |
Midtvedt K.,University of Oslo
Drugs and Aging | Year: 2013
Organ transplantation is increasingly common in the older population, particularly among end-stage renal disease patients. The outcomes of transplantation are often inferior in older people compared with younger recipients, partly because of the side effects of immunosuppressive medication used after organ transplantation. In this paper, we explore treatment considerations for older transplant patients. The current commonly used immunosuppressive protocols have not been validated sufficiently in older organ recipients. The primary objective for the management of transplant recipients of all ages is to prevent rejection without increasing the risk of infection or other long-term complications. To avoid serious side effects related to immunosuppressive treatment, the clinician should consider modifying and tailoring the long-term regimen for individual patients. Modifications for older recipients include reduction in the dosage or avoidance of calcineurin inhibitors, with or without the introduction of a mammalian target of rapamycin inhibitor and discontinuing the use of corticosteroids. Such modifications must consider the individual risks and needs of each recipient. Treatment of an acute rejection episode should follow the same protocol as for younger recipients, but special attention is needed to ensure reduction in the total immunosuppressive load. One way to achieve this is to avoid anti-thymocyte globulin (ATG) induction and to use on-demand ATG treatment of rejection on the basis of the patient's CD3 T cell count. © 2013 Springer International Publishing Switzerland.
Paulsen O.,Telemark Hospital |
Paulsen O.,Norwegian University of Science and Technology |
Aass N.,University of Oslo |
Kaasa S.,Norwegian University of Science and Technology |
Dale O.,Norwegian University of Science and Technology
Journal of Pain and Symptom Management | Year: 2013
Context: Corticosteroids are frequently used in cancer patients for their analgesic properties. The evidence for analgesic effects of corticosteroids in palliative care has not been established. Objectives: To assess the evidence for the use of corticosteroids in cancer pain management. Methods: A systematic literature search was performed. The articles were evaluated according to the Grading of Recommendations Assessment, Development and Evaluations system by two independent reviewers. Results: The search provided 514 references, four of which were included. Another two trials were identified from reference lists. Two of these six studies were excluded from the qualitative review. One crossover study showed a significant reduction in pain intensity of 13 (visual analogue 0-100 scale) accompanied by significant lower analgesic consumption in favor of the steroid group. In another study, the addition of steroids did not have any effect on pain. In two studies, outcomes of pain intensity or analgesic consumption were not adequately reported. However, one of these studies showed significant pain reduction, whereas the other found no effect. Corticosteroids given in medium doses were well tolerated in studies for up to seven days. However, the studies indicated that corticosteroids may have serious toxicity and even higher mortality when administered in high doses over eight weeks. Conclusion: Corticosteroids may have a moderate analgesic effect in cancer patients. The paucity of relevant studies was striking; consequently, the evidence was graded as "very low." More studies addressing the analgesic efficacy in cancer patients are required. © 2013 U.S. Cancer Pain Relief Committee.Published by Elsevier Inc. All rights reserved.
Hoff G.,Telemark Hospital |
Dominitz J.A.,University of Washington
Gut | Year: 2010
In the recent 1-2 decades, we have seen a considerable development in colorectal cancer (CRC) screening modalities and programme implementation, but major challenges remain. While CRC is still the second leading cause of cancer death in both the USA and Europe, there are limited data on the efficacy and effectiveness of all screening modalities except for the faecal occult blood test (FOBT). Newer screening tests, such as faecal immunochemical tests, molecular markers and CT colonography are being introduced and variably adopted, though overall rates of screening are suboptimal. Professional societies and governmental bodies have endorsed screening, though recommended approaches are quite variable, which may help to explain the great variation in screening practices. Unfortunately, quality assurance programmes are underutilised. Comparing the USA and Europe there may be more variation in CRC screening recommendation and practice within each continent than between them, but there seems to be a stronger emphasis on programmatic screening in Europe, facilitating quality assurance. The much debated need for randomised trials as new screening modalities emerge could be more easily handled if running screening programmes are regarded as natural platforms for testing out and evaluating presumed improvements in the service - including new emerging screening modalities.
Oellingrath I.M.,Telemark University College |
Svendsen M.V.,Telemark Hospital |
Brantsaeter A.L.,Norwegian Institute of Public Health
European Journal of Clinical Nutrition | Year: 2010
Background/Objectives:Increasing prevalence of overweight in children is a growing health problem. The aim of this study was to describe the eating patterns of 9- to 10-year-old schoolchildren, and to investigate the relationship between overweight and eating patterns.Subjects/Methods:We recruited 1045 children for a cross-sectional study in Telemark County, Norway. The children's food, snacking and meal frequencies were reported by their parents using a retrospective food frequency questionnaire. Height and weight were measured by health professionals, and body mass index categories were calculated using international standard cutoff points (International Obesity Task Force values). Complete data were obtained for 924 children. Four distinct eating patterns were identified using principal component analysis. We used multiple logistic regression and calculated odds ratios (ORs) with 95% confidence intervals (CIs) for being overweight, and adjusted for parental characteristics and physical activity levels of the children (aORs).Results:Parental characteristics and physical activity were associated with both obesity and eating patterns. Children adhering to a junk/convenient eating pattern had a significantly lower likelihood of being overweight (aOR: 0.6; 95% CI: 0.4, 0.9), whereas children adhering to a varied Norwegian or a dieting eating pattern had a significantly higher likelihood of being overweight (respective values: aOR: 2.1; 95% CI: 1.3, 3.2; aOR: 2.2; 95% CI: 1.4, 3.4). No association with overweight was seen for a snacking pattern.Conclusions:The main finding was that, although family characteristics influenced both the prevalence of overweight and overall dietary behaviour, independent associations were evident between eating patterns and overweight, indicating parental modification of the diets of overweight children. © 2010 Macmillan Publishers Limited All rights reserved.
Hoff G.,Telemark Hospital
Nature Reviews Gastroenterology and Hepatology | Year: 2014
In an update on recommendations for colorectal cancer screening, an Asia-Pacific consensus group has set a good standard for presenting level of agreement to recommendation levels. However, this update also exposes how consensus groups might concentrate on the less controversial issues-leaving the tricky questions in the dark. © 2014 Macmillan Publishers Limited.
Gunnarsson G.L.,Telemark Hospital
Annals of Plastic Surgery | Year: 2016
ABSTRACT: Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)–targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps. We performed 148 reconstructions in 130 patients. Eleven facial reconstructions, 118 reconstructions in the body, 7 in the upper limbs, and 12 in the lower limbs. The propeller flap was used in 135 of 148 (91%) cases followed by the turnover design in 10 (7%) and the V to Y flap in 3 (2%) cases. The flaps were raised on 1 perforator in 98 (67%), 2 perforators in 48 (33%), and 3 perforators in 2 (1%) flaps. The reconstructive goal was achieved in 143 of 148 reconstructions (97%). In 5 cases, surgical revision was needed. No flaps were totally lost indicating a patent pedicle in all cases. We had 10 (7%) cases of major complications and 22 (15%) minor complications. The CDU-targeted perforator mapping and angiosome-based flap reconstruction are simple to perform, and we recommended its use for freestyle perforator flap reconstruction. All perforators selected by CDU was identified during surgery and used for reconstruction. The safe boundaries of angiosomes remain to be established. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Holla O.L.,Telemark Hospital |
Bock G.,Telemark Hospital |
Busk O.L.,Telemark Hospital |
Isfoss B.L.,Telemark Hospital
Endoscopy | Year: 2014
A 55-year-old woman with a history of bowel dysmotility presented with abdominal distension and peritonitis. Family history included premature deaths with intestinal symptomatology, suggesting autosomal dominant inheritance. Computed tomography showed a distended small bowel. Symptoms were alleviated by enterocutaneous stomas. Initial ileal biopsy suggested neuropathy; however, exome sequencing revealed an Arg148Ser mutation in the enteric smooth muscle actin gamma 2 (ACTG2) gene. Histological reassessment showed abnormal muscularis propria and smooth muscle actin, with the same findings in sibling, confirming familial visceral myopathy. Thus, noninvasive genomic analysis can provide early and specific diagnosis of familial visceral myopathy, which may help to avoid inappropriate surgery. © Georg Thieme Verlag KG Stuttgart · New York.
Isfoss B.L.,Telemark Hospital
BJU International | Year: 2011
What's known on the subject? and What does the study add? Fluorescent-light cystoscopy has a high sensitivity, relative to that of white light cystoscopy, for carcinoma in situ of the bladder. However, this systematic review reveals that the absolute sensitivity is unknown due to the absence of proper gold standard which is microscopic examination of whole bladders. A literature search was conducted to identify peer-reviewed study reports on the sensitivity of fluorescent-light cystoscopy (FLC) for the detection of carcinoma in situ (CIS) of the bladder. Data from 16 original studies comprising 1503 patients were pooled. The claimed sensitivity of FLC for detecting patients with CIS using the most commonly reported intravesical agents 5-aminolevulinic acid or hexaminolevulinic acid was 92.4%, while that of white-light cystoscopy (WLC) was 60.5%. The two agents did not differ significantly for sensitivity. It must be pointed out that a 'gold standard' is lacking in FLC studies. The occurrence of CIS of the bladder can only be established by the pathological examination of whole bladders. The true sensitivities of various modes of cystoscopy for detecting CIS can be revealed if patients scheduled for cystectomy are first examined with WLC, FLC, and optionally random biopsies. The absolute sensitivity of FLC for detecting CIS of the bladder is not yet known. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.