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  • 1.
    Andersson, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Olaison, Gunnar
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Bodemar, Göran
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Almer, Sven
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Arvidsson, M.
    Dabrosin-Söderholm, J.
    Nyström, Per-Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Smedh, K.
    Ström, Magnus
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Low symptomatic load in Crohn's disease with surgery and medicine as complementary treatments1998In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 33, no 4, p. 423-429Article in journal (Refereed)
    Abstract [en]

    Background: The treatment of Crohn's disease has changed owing to the recognition of its chronicity. Medical maintenance treatment and limited resections have evolved as major concepts of management, regarded as complementary, and both aim at reducing the symptoms.

    Methods: We investigated the symptomatic load in Crohn's disease as reflected in a cross-sectional study of the symptom index, physicians' assessment, and the patients' perception of health. A cohort of 212 patients from the primary catchment area and 125 referred patients were studied.

    Results: Of catchment area patients, 83% were receiving medication, and the annual rate of abdominal surgery was 5.7%. Corresponding figures for the referred patients were 82% and 10.3%. According to the symptom index, 87% of catchment area patients were in remission or had only mild symptoms; according to the physicians' assessment, 90% were. The patients' median perception of health was 90% of perfect health according to the visual analogue scale. The figures were similar for referred patients, except that referrals were considered more diseased by the physician.

    Conclusion: The great majority of patients with Crohn's disease are able to live in remission or experience only mild symptoms.

  • 2.
    Andersson, Peter
    et al.
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Olaison, Gunnar
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Bodemar, Göran
    Linköping University, Department of Molecular and Clinical Medicine, Gastroenterology and Hepatology. Linköping University, Faculty of Health Sciences.
    Nyström, Per-Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Surgery for Crohn colitis over a twenty-eight-year period: fewer stomas and the replacement of total colectomy by segmental resection2002In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    Background: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced.

    Methods: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods.

    Results: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% ( P < 0.01) while stricture as an indication increased from 9% to 50% ( P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years ( P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery ( P = 0.017), permanent stoma ( P < 0.01) and total colectomy ( P < 0.01). Findings were similar in the population-based cohort.

    Conclusions: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.

  • 3. Andersson, R
    et al.
    Hugander, A
    Ghazi, SH
    Ravn, H
    Offenbartl, K
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis.1999In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 23, p. 133-140Article in journal (Refereed)
  • 4. Andersson, Roland
    et al.
    Hugander, Anders
    Ravn, Hans
    Offenbartl, Karsten
    Ghazi, Sam
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Repeated clinical and laboratory examinations in patients with an equivocal diagnosis of appendicitis2000In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 24, no 4, p. 479-485Article in journal (Refereed)
    Abstract [en]

    In-hospital observation with repeated clinical examinations is commonly used in patients with an equivocal diagnosis of appendicitis. It is not known if repeated measurements of temperature and laboratory examinations have any diagnostic importance in this situation. The importance of repeated measurements of the body temperature, white blood cell (WBC) and differential cell counts, C-reactive protein concentration (CRP) and of the surgeon's repeated assessments was prospectively analyzed in 420 patients with an equivocal diagnosis of appendicitis at admission who were reexamined after a median of 6 hours of observation. The final diagnosis was appendicitis in 137 patients. After observation the inflammatory response was increasing among patients with appendicitis and decreasing among patients without appendicitis. The variables discriminating power for appendicitis consequently increased, from an area under the receiver operating characteristic (ROC) curve of 0.56 to 0.77 at admission, to 0.75 to 0.85 after observation. The ROC area of the surgeons' clinical assessment increased from 0.69 to 0.89. The WBC and differential cell counts were the best discriminators at the repeat examination. The change in the variables between the observations had weak discriminating power and had no additional importance in addition to the actual level at the repeat examination. To conclude, the diagnostic information of the temperature and laboratory examinations increased after observation. Repeated controls of the body temperature and laboratory examinations are therefore useful in the management of patients with equivocal signs of appendicitis, but the result of the examinations must be integrated with the clinical assessment.

  • 5.
    Andersson, Roland
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery .
    Hugander, AP
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ghazi, SH
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Ravn, H
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Offenbartl, SK
    Ryhov Hosp, Dept Surg, SE-55185 Jonkoping, Sweden Ryhov Hosp, Dept Clin Pathol, SE-55185 Jonkoping, Sweden Highlands Hosp, Dept Surg, Eksjo, Sweden Linkoping Univ Hosp, Dept Surg, Linkoping, Sweden.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Olaison, Gunnar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Why does the clinical diagnosis fail in suspected appendicitis?2000In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 166, no 10, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Objective: To identify systematic errors in surgeons' estimations of the importance of diagnostic variables in the decision to explore patients with suspected appendicitis. Design: Prospective case series. Setting: Two emergency departments, Sweden. Patients: 496 patients with suspected appendicitis on admission, of whom 194 had a correct operation for appendicitis and 59 had a negative exploration. Main outcome measures: Predictors of a negative exploration expressed as the odds ratio (OR) for negative exploration. Variables influence on the decision to operate, expressed as the OR for operation, compared with the true diagnostic importance, expressed as the OR for appendicitis. Results: Predictors of negative explorations were high ratings in variables describing pain and tenderness (patient's perceived pain, abdominal tenderness, rebound tenderness, guarding or rectal tenderness), weak or absent inflammatory response, female sex, long duration of symptoms and absence of vomiting, with OR of 1.8-3.0. Pain and tenderness had too strong an influence on the decision to operate whereas the lack of an inflammatory response, no vomiting, and long duration of symptoms were not given enough attention. There was no sex difference in the proportion of patients with non-surgical abdominal pain (NSAP) who were operated on, but NSAP was more common and appendicitis less common among women, leading to a larger proportion of negative appendicectomies among women. Conclusion: Negative explorations in patients with suspected appendicitis are related to systematic errors in the clinical diagnosis with too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation. Rectal tenderness is not a sign of appendicitis. The risk of diagnostic errors is similar in men and women.

  • 6.
    Bauhofer, A.
    et al.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Lorenz, W.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Stinner, B.
    Department of General Surgery, Philipps-University Marburg, Germany.
    Rothmund, M.
    Department of General Surgery, Philipps-University Marburg, Germany.
    Koller, M.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Sitter, H.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Celik, I.
    Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Farndon, J.R.
    Department of Surgery, Bristol Royal Infirmary, Bristol, United Kingdom.
    Fingerhut, A.
    Department of Surgery, Centre Hospitalier Intercommunal, Poissy, France.
    Hay, J.M.
    Department of Surgery, Hopital Louis Mourier, Colombes, France.
    Lefering, R.
    2nd Department of Surgery, University of Cologne, Germany.
    Lorijn, R.
    AMGEN Europe, Lucerne, Switzerland.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Schafer, H.
    Schäfer, H., Institute of Medical Biometrics and Epidemiology, Philipps-University Marburg, Germany.
    Schein, M.
    Department of Surgery, New York Methodist Hospital, Cornell University, United States.
    Solomkin, J.
    Department of Surgery, University of Cincinnati, College of Medicine, United States.
    Troidl, H.
    2nd Department of Surgery, University of Cologne, Germany.
    Volk, H.-D.
    Institute of Medical Immunology, Humboldt-University Berlin, Germany.
    Wittmann, D.H.
    Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
    Wyatt, J.
    School of Public Policy, University College London, United Kingdom.
    Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). Protocol for a controlled clinical trial developed by consensus of an international study group: Part two2001In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 50, no 4, p. 187-205Article, review/survey (Refereed)
    Abstract [en]

    General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4) This part describes the design of the randomised, placebo controlled, double-blinded, single-centre study performed at an university hospital (n = 40 patients for each group). Objective: The trial design includes the following elements for a prototype protocol: - The study population is restricted to patients with colorectal cancer, including a left sided resection and an increased perioperative risk (ASA 3 and 4). - Patients are allocated by random to the control or treatment group. - The double blinding strategy of the trial is assessed by psychometric indices - An endpoint construct with quality of life (EORTC QLQ-C30) and a recovery index (modified Mc Peek index) are used as primary endpoints Qualitative analysis of clinical relevance of the endpoints is performed by both patients and doctors. - Statistical analysis uses an area under the curve (AUC) model for improvement of quality of life on leaving hospital and two and six months after operation. A confirmatory statistical model with quality of life as the first primary endpoint in the hierarchic test procedure is used. Expectations of patients and surgeons and the negative affect are analysed by social psychological scales. Conclusion: This study design differs from other trials on preoperative prophylaxis and postoperative recovery, and has been developed to try a new concept and avoid previous failures.

  • 7.
    Cheetham, MJ
    et al.
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Mortensen, NJM
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kamm, MA
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Phillips, RKS
    St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
    Persistent pain and faecal urgency after stapled haemorrhoidectomy2000In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 356, no 9231, p. 730-733Article in journal (Refereed)
    Abstract [en]

    Introduction Haemorrhoidectomy usually cures haemorrhoids. Day surgery is feasible, and is associated with high patients' satisfaction and few complications, but patients take an average of 2 weeks off work after surgery. Stapled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on longterm efficacy and function are lacking. Methods 22 patients underwent stapled haemorrhoidectomy: seven in a pilot study, and 15 in a randomised controlled trial to compare the new stapled operation with diathermy haemorrhoidectomy in a day-case setting. All operations were done by one consultant surgeon. Results 16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency which persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, anorectal physiology, and examination under anaesthetic. All five affected patients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to an anodermal ulcer, in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms, Interpretation Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorporation in the doughnut may have a role, Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.

  • 8.
    Corman, ML
    et al.
    Stony Brook University.
    Carriero, A
    Hager, T
    Herold, A
    Jayne, DG
    Lehur, PS
    Lomanto, D
    Longo, A
    Mellgren, AF
    Nicholls, J
    Nyström, Per-Olof
    Karolinska University Hospital .
    Senagore, AJ
    Stuto, A
    Wexner, SD
    Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation2006In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 8, no 2, p. 98-101Article in journal (Refereed)
    Abstract [en]

    An international working party was convened in Rome, Italy on 16–17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.

  • 9. Corman, ML
    et al.
    Gravié, J-F
    Hager, T
    Loudon, MA
    Mascagni, D
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Seow-Choen, F
    Abcarian, H
    Marcello, P
    Weiss, E
    Longo, A
    Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique2003In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 5, p. 304-310Article in journal (Refereed)
  • 10.
    Gerjy, Roger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Derwinger, Kristoffer
    Colorectal Surgery, Department of Surgery, Salgrenska University Hospital, Östra, Göteborg, Sweden.
    Nyström, Per-Olof
    Colorectal Surgery, Department of Surgery, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    Perianal local block for stapled anopexy2006In: Diseases of the colon and rectum, ISSN 0012-3706, Vol. 49, no 12, p. 1914-1921Article in journal (Refereed)
    Abstract [en]

    Purpose This study was designed to demonstrate the usefulness of a method of regional anesthesia for circular stapler anopexy for prolapsing hemorrhoids.

    Methods Thirty-three patients consented to stapled anopexy under perianal local anesthesia. Eighteen patients with stapled anopexy under general anesthesia were controls. The perianal block was applied with 40 ml of ropivacaine, 4.75 mg/ml, injected immediately peripheral to the external sphincter. A submucosal block with 15 ml of ropivacaine, 2 mg/ml, was added after applying the pursestring suture. Postoperative pain was rated by the patient for 14 days by using a ten-point visual analogue scale. Patients also submitted a preoperative and postoperative (3–6 months) symptom questionnaire to rate anal symptoms.

    Results No operation was converted to general anesthesia. Operation time was similar in both groups. All patients in the local anesthesia group were pain free at discharge. The sums of pain scores during 14 days for daily average pain and peak pain were similar in both groups (average pain 23 (local anesthesia) vs. 35 (general anesthesia); peak pain 39 (local anesthesia) vs. 50 (general anesthesia); P > 0.05). The preoperative symptom scores were 7.8 (local anesthesia) vs. 8.9 (general anesthesia) points, and the follow-up scores were 2.2 (local anesthesia) and 2.7 (general anesthesia), a significant improvement (P = 0.001) in both groups but not different between groups.

    Conclusions A perianal local block is easy to apply and has a high degree of acceptance among patients. The operation time, postoperative pain, and success rates of the operation equaled those of stapled anopexy performed under general anesthesia. The advantages are quicker turnover between cases and simpler management of pain-free postoperative patients in day surgery.

  • 11.
    Gerjy, Roger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lindhoff-Larson, A.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Nyström, P.-O.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Prolapse grade and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients2008In: Colorectal disease, ISSN 1462-8910, Vol. 10, no 7, p. 694-700Article in journal (Refereed)
    Abstract [en]

    Purpose: Haemorrhoid prolapse is an indication for surgery. A correlation between worsening anatomy and increasing symptoms is commonly assumed. We developed a classification algorithm of prolapse and external component, and evaluated its correlation to symptoms before and after surgery.

    Method: A study population comprising 180 patients operated for haemorrhoids in a multicentre randomized trial plus a validation set comprising 90 patients operated by us. The classification used three items: (i) patient self-report of prolapse requiring manual reposition; (ii) surgeon assessment of prolapse when patient negated manual reposition; (iii) surgeon assessment of external component. Patient self-reported were rated by frequency (never, 0 points; monthly, 1 point; weekly, 2 points and daily, 3 points). The algorithm yielded three grades: 1, no prolapse; 2, spontaneously reducing prolapse and 3, prolapse needing manual repositioning. The degree of external component was affixed as A, none; B, one or few tags and C, circumferential.

    Results: Anatomical grades did not differ between the two sets of patients before or after surgery. Preoperatively, 69% had grade 3 prolapse. Postoperatively, 89% were classified as grades 1A or B. The symptom load was similar for grades 2 and 3; mean 6.5 points preoperatively and 1.8 points postoperatively.

    Conclusion: This anatomical classification, based on strict criteria, reliably staged the haemorrhoid prolapse. There was no unique preoperative symptom profile associated with any degree of prolapse with or without an external component. Restored anal anatomy relieved symptoms. The classification also defined recurrence of haemorrhoids.

  • 12.
    Gerjy, Roger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Nyström, Per-Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Excision of residual skin tags during stapled anopexy does not increase postoperative pain2007In: Colorectal Disease, ISSN 1462-8910, Vol. 9, no 8, p. 754-757Article in journal (Refereed)
    Abstract [en]

    Objective: We studied whether excision of residual external skin tags causes additional pain in patients undergoing a stapled anopexy for muco-anal prolapse.

    Method: Seventeen patients in whom skin tags had been excised were compared with 24 patients having no excision. The patients were selected from a prospective database of haemorrhoid surgery if they had submitted a diary with self-reported postoperative pain scores as well as a self-reported symptom questionnaire preoperatively and postoperatively. The tags were excised with preservation of the subdermal fascia.

    Results: There were 41 patients who fulfilled the criteria for inclusion. Seventeen (group 1) had tags excised and 24 (group 2) did not. Fifty-nine per cent in group 1 and 67% in group 2 experienced preoperative prolapse needing manual reposition. The mean height of the staple line was 2 cm above the dentate line in both groups. Daily average postoperative pain recorded as the sum of a self-reported VAS rating over 14 days was 26 points in both groups. The peak pain experienced was 42 and 43 points respectively (not significant). Resolution of postoperative pain over 14 days was identical. The preoperative and postoperative symptom score was comparable in both groups.

    Conclusion: Excision of anal skin tags should be carried out at the time of stapled anopexy.

  • 13.
    Hallböök, Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Matthiessen, P
    Leinsköld, Ted
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Safety of the temporary loop ileostomy2002In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 4, no 5, p. 361-364Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the complications of the temporary loop ileostomy. Method. A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. Results. Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. Conclusion. In this series closure of the ostomy was associated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.

  • 14.
    Lorenz, W.
    et al.
    Institute of Theoretical Surgery, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Stinner, B.
    Department of General Surgery, Philipps-University of Marburg, Germany.
    Bauhofer, A.
    Institute of Theoretical Surgery, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Rothmund, M.
    Department of General Surgery, Philipps-University of Marburg, Germany.
    Celik, I.
    Institute of Theoretical Surgery, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Fingerhut, A.
    Surgical Unit, Centre Hospitalier Intercommunal, Poissy (Paris), France.
    Koller, M.
    Institute of Theoretical Surgery, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Lorijn, R.H.W.
    AMGEN Europe, Lucerne, Switzerland.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sitter, H.
    Institute of Theoretical Surgery, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
    Schein, M.
    Cornell University, Medical College, NY, United States.
    Solomkin, J.S.
    Department of Surgery, University of Cincinnati College of Medicine, United States.
    Troidl, H.
    2nd Department of Surgery, University of Cologne, Germany.
    Wyatt, J.
    School of Public Policy, University College London, United Kingdom.
    Wittmann, D.H.
    Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
    Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4): Part one2001In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 50, no 3, p. 115-122Article, review/survey (Refereed)
    Abstract [en]

    General design: Presentation of a novel study protocol to evalue the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). The rationale and hypothesis are presented in this part of the protocol of the randomised, placebo controlled, double-blinded, single-centre study performed at an - university hospital (n = 40 patients for each group). Objective: Part one of this protocol describes the concepts of three major sections of the study: - Definition of optimum and sub-optimal recovery after operation. Recovery, as an outcome, is not a simple univariate endpoint, but a complex construction of mechanistic variables (i. e. death, complications and health status assessed by the surgeon), quality of life expressed by the patient, and finally a weighted outcome judgement by both the patient and the surgeon (true endpoint). Its conventional early assessment within 14-28 days is artificial: longer periods (such as 6 months) are needed for the patient to state: "I am now as well as I was before". Identification of suitable target patients: - the use of biological response modifiers (immune modulators) in addition to traditional prophylaxes (i. e. antibiotics, heparin, volume substitutes) may improve postoperative outcome in appropriate selected patients with reduced host defence and increased immunological stress response, but these have to be defined. Patients classified as ASA 3 and 4 (American Society for Anaesthesiologists) and with colorectal cancer will be studied to prove this hypothesis. Choice of biological response modifier: - Filgrastim has been chosen as an example of a biological response modifier because it was effective in a new study type, clinic-modelling randomised trials in rodents, and has shown promise in some clinical trials for indications other than preoperative prophylaxis. It has also enhanced host defence and has been anti-inflammatory in basic research. Conclusion: The following hypothesis will be tested in patients with operations for colorectal cancer and increased preoperative risk (ASA 3 and 4): is the outcome as evaluated by the hermeneutic endpoint (quality of life expressed by the patient) and mechanistic endpoints (mortality rate, complication rate, relative hospital stay, assessed by the doctor) improved in the group receiving filgrastim prophylaxis in comparison with the placebo group? Quality of life will be the first primary endpoint in the hierarchical, statistical testing of confirmatory analysis.

  • 15. Lund, JN
    et al.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Coremans, G
    Herold, A
    Karaitianos, I
    Spyrou, M
    Schouten, WR
    Sebastian, AA
    Pescatori, M
    An evidence-based treatment algorithm for anal fissure2006In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 10, no 3, p. 177-180Article in journal (Refereed)
    Abstract [en]

       

  • 16. Machado, Mikael
    et al.
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Goldman, Sven
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Järhult, Johannes
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: A comparison between two hospitals with a different policy2002In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 45, no 7, p. 940-945Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to compare surgical outcome, after low anterior resection for rectal cancer with colonic J-pouch, at two departments with a different policy regarding the use of a routine diverting stoma. METHODS: A total of 161 consecutive patients with invasive rectal carcinomas operated on between 1990 and 1997 with a total mesorectal excision and a colonic J-pouch were included in the study. Eighty patients were operated on in a surgical unit using routine defunctioning stomas (96 percent), whereas 81 were operated on in a department in which diversion was rarely used (5 percent). Recorded data with respect to surgical outcome were analyzed and compared. RESULTS: There was no difference between the two centers in postoperative mortality in connection with the primary resection and subsequent stoma reversal (3.7 vs. 3.8 percent). No significant difference could be found in the number of patients with pelvic sepsis (anastomotic leaks, 9 vs. 12 percent). Surgical outcome in patients with pelvic sepsis was also similar. The frequency of reoperations associated with the anterior resection and subsequent stoma reversal was identical (14 percent). The total hospital stay (primary operation and stoma reversal) was significantly longer with than without a routine stoma (17 (range, 2-59) vs. 12 (range, 5-55) days, respectively, P < 0.001). CONCLUSION: This study suggests that the routine use of diversion does not protect the patient from anastomotic complications or pelvic sepsis and its use requires a second admission for closure.

  • 17.
    Morren, Geert
    et al.
    Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
    Hallböök, Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Nyström, Per-Olof
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Baeten, C. G. M. I.
    Department of General Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
    Sjödahl, Rune
    Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
    Audit of anal-sphincter repair2001In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 3, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    Objective

    Structural damage of the anterior part of the anal sphincter is a major cause of faecal incontinence. Sphincter repair is the standard surgical treatment. This study was designed to analyse the results of anal sphincter repair, to identify possible predictors of outcome and to investigate the presence of bowel symptoms other than leakage at follow up.

    Patients and methods

    Fifty-five women (median age 39 years, range 24–73 years) who underwent anal sphincter repair between 1986 and 1997 at the University Hospital of Linköping answered a postal questionnaire. Current bowel function, degree of continence and the patients’ functional result as worse, unchanged, some improvement, good or excellent were assessed. Good or excellent function was regarded as a successful result, the rest as failure. Age, duration of symptoms, type of surgery, morbidity and length of follow up were analysed in relation to outcome. Results of pre- and post-operative anal manometry, endoanal ultrasound, anal sphincter electromyography and pudendal nerve function were also analysed.

    Results

    After a median (range) follow-up period of 40 months (5–137) months, 31 (56%) patients rated the result as either excellent (n=10) or good (n=21). Twenty-one (38%) patients rated the result as some improvement (n=14), unchanged (n=6) or worse (n=1). In three (5%) patients a colostomy was fashioned because of failure. Patients >50 years at surgery (n=18) had a worse outcome (P=0.001). Successful outcome was correlated to increased squeeze pressures post-operatively. The presence of post-operative urgency (P=0.01) and loose stools (P=0.02) was more common in patients with poor outcome. Eight patients became continent to formed and liquid stool.

  • 18.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Difficult to measure results and quality of surgical interventions but length of stay is an important variable2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, p. 184-189Article in journal (Other academic)
  • 19.
    Nyström, Per-Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Derwinger, K
    Gerjy, Roger
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Local perianal block for anal surgery2004In: Techniques in Coloproctology, ISSN 1123-6337, E-ISSN 1128-045X, Vol. 8, no 1, p. 23-26Article in journal (Refereed)
    Abstract [en]

    Background: We refined a technique for local block of all terminal nerve branches to the anus. Methods: A total of 30 consecutive patients with proctological disorders consented to ambulatory (n=29) or hospitalised (n=1) operation with local perianal block for skin tags, Milligan-Morgan haemorrhoidectomy, stapled haemorrhoidopexy or anocutaneous fistulae. Patients were operated prone. A total of 40 ml of a 4.75 mg/ml solution of ropivacaine (Narop, Astra, Sweden) was injected in 8 directions (5 ml each) into the ischiorectal fat immediately peripheral to the external sphincter as anaesthetic columns reaching from the skin to the levator. This injection scheme targets the terminal nerve branches of the anus rather than blocking the trunk of major nerves. The relaxation of a pain-free anus was obtained in 2-3 minutes with exposure similar to a general anaesthetic. Postoperative pain was evaluated on a 0 to 10 visual analogue scale (VAS). Results: Patients were pain-free at discharge. However, mean postoperative VAS score at 24 hours was 3.2 following Milligan-Morgan haemorrhoidectomy, 4.8 following stapled haemorrhoidopexy and skin tags or polyps excision, and 2.7 after fistula lay-open. At telephone follow-up 1-2 weeks later, the patients were satisfied with the method of anaesthesia and would willingly accept it for any further anal surgery. Conclusions: The perianal block is easy to apply and effective as sole method of anaesthesia for proctological operations.

  • 20.
    Nyström, Per-Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Laparoscopic sigmoid resection for diverticular disease1999In: Zentralblatt für Chirurgie, ISSN 0044-409X, E-ISSN 1438-9592, Vol. 124, no 12, p. 1147-1151Article in journal (Refereed)
    Abstract [en]

    It is still difficult to determine the exact indication for a laparoscopic sigmoid resection for diverticular disease. Frequently, the severity of diverticulitis is not sufficiently defined. For this reason a modification of the Hinchey classification is proposed to which a stage II b for fistula formation and a differentiation between acute and chronic disease have been added. Another problem is the lack of criteria which define a "laparoscopic" resection. A sigmoid resection should be called "laparoscopic" if the mobilization of the sigmoid colon, the transsection of the mesenteric vein and artery and the mesentery itself and the distal transsection of the bowel are done laparoscopically. The resection of the bowel and the introduction of the anvil of the stapler device can be done extraabdominally, however, the anastomosis again should be performed laparoscopi- cally. A so defined sigmoid rejection can be done in the chronic stage I. In the chronic stage II a there will be significant problems due to adhesion formation, and in the acute stages II a and II b as well as in the chronic stage II b a laparoscopic resection should not be attempted.

  • 21.
    Nyström, Per-Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Kald, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, MKC-2, GE: Gastrokir.
    Laparoskopische Sigmaresektion bei Divertikulitis.1999In: Zentralblatt für Chirurgie, ISSN 0044-409X, E-ISSN 1438-9592, Vol. 124, p. 1147-1151Article in journal (Refereed)
  • 22.
    Nyström, Per-Olof
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wittman, D
    Patient to surgeon infections - Fact or fiction2003In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 90, no 11, p. 1315-1316Article in journal (Refereed)
  • 23.
    Olaison, Gunnar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Runström, Birgitta
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sjödahl, Rune
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Enterokutana fistlar - krävande tillstånd som kan opereras till läkning. Modern behandling och kirurgisk erfarenhet minskar mortaliteten2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 11, p. 861-865Article in journal (Other academic)
  • 24.
    Stinner, B
    et al.
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Bauhofer, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lorenz, W
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Rothmund, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Plaul, U
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Torossian, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Celik, I
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Sitter, H
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Koller, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Black, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Duda, D
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Encke, A
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Greger, B
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    van Goor, H
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Hanisch, E
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Hesterberg, R
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Klose, KJ
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lacaine, F
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Lorijn, RHW
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Margolis, C
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Neugebauer, E
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Nyström, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Reemst, PHM
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Schein, M
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Solovera, J
    Univ Marburg, Inst Theoret Surg, D-35033 Marburg, Germany Univ Marburg, Dept Gen Surg, D-35032 Marburg, Germany Univ Marburg, Dept Anaesthesia & Intens Care Med, D-35032 Marburg, Germany Bristol Royal Infirm, Dept Anaesthesia, Bristol, Avon, England Rot Kreuz Clin, Dept Surg, Kassel, Germany Univ Frankfurt, Dept Surg, D-6000 Frankfurt, Germany Dept Surg, Lichtenfels, Germany Univ Nijmegen, Med Ctr, Dept Surg, Nijmegen, Netherlands Knappschafts Clin, Dept Surg, Dortmund, Germany St Hildegardes Clin, Dept Anaesthesia, Mainz, Germany Univ Marburg, Dept Radiol, D-35032 Marburg, Germany Hosp Tenon, Dept Surg, Paris, France Amgen Inc Europe, Lucerne, Switzerland Ben Gurion Univ Negev, Fac Hlth Sci, Ctr Med Descis Making, IL-84105 Beer Sheva, Israel Univ Cologne, Dept Surg 2, Biochem & Expt Div, D-5000 Cologne 41, Germany Linkoping Univ, Dept Med Surg Gastroenterol, S-58183 Linkoping, Sweden Diakonissenhuis, Dept Surg, Eindhoven, Netherlands Cornell Univ, New York Methodist Hosp, Dept Surg, Ithaca, NY 14853 USA.
    Granulocyte-colony stimulating factor in the prevention of postoperative infectious complications and sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4) - Protocol of a controlled clinical trial developed by consensus of an international study group Part three: individual patient, complication algorithm and quality management2001In: Inflammation Research, ISSN 1023-3830, E-ISSN 1420-908X, Vol. 50, no 5, p. 233-248Article, review/survey (Refereed)
    Abstract [en]

    General design: Presentation of a new type of a study protocol for evaluation of the effectiveness of an immune modifier (rhG-CSF, filgrastim): prevention of postoperative infectious complications and of sub-optimal recovery from operation in patients with colorectal cancer and increased preoperative risk (ASA 3 and 4). A randomised placebo controlled, double-blinded, single-centre study is performed at an University Hospital (n = 40 patients for each group). This part presents the course of the individual patient and a complication algorithm for the management of anastomotic leakage and quality management. Objective: In part three of the protocol, the three major sections include: - The course of the individual patient using a comprehensive graphic display, including the perioperative period, hospital stay and post discharge outcome. - A center based clinical practice guideline for the management of the most important postoperative complication anastomotic leakage - including evidence based support for each step of the algorithm. - Data management, ethics and organisational structure. Conclusions: Future studies with immune modifiers will also fail if not better structured (reduction of variance) to achieve uniform patient management in a complex clinical scenario. This new type of a single-centre trial aims to reduce the gap between animal experiments and clinical trials or - if it fails - at least demonstrates new ways for explaining the failures.

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