Publications by authors named "Egil Johnson"

54 Publications

Short-, long-, and very long-term results of secondary anterior sphincteroplasty in 20 patients with obstetric injury.

Int J Colorectal Dis 2021 Sep 16. Epub 2021 Sep 16.

Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Ullevål, P. O. Box 4956, 0424, Nydalen, Oslo, Norway.

Purpose: More long-term follow-up studies beyond 10 years after secondary sphincteroplasty for obstetric damage are warranted. This prospective study aimed to compare reported data on incontinence and satisfaction in a cohort of such patients examined at short-, long-, and very long-term follow-up.

Methods: Twenty out of 33 obstetric patients (61%) operated with secondary anterior overlapping sphincteroplasty during February 1996 to April 2004 were evaluated preoperatively and at short-, long-, and very long-term follow-up. Anal incontinence was scored by a combination of Wexner's and St. Mark's incontinence scores. The patients also reported degree of treatment satisfaction.

Results: Twenty patients were examined preoperatively and after a median (range) of 5 (2-62), 102 (64-162), and 220 (183-278) months. Corresponding incontinence scores were 11.5 (5-18), 5.5 (1-17) (p < 0.01), 10.0 (0-18) (p > 0.05), and 12.0. (1-18) (p > 0.05). With increasing follow-up times, patients reporting a better outcome were 75%, 65%, and 45%. At very long-term follow-up patients, reports were more dismal than expected in those also reporting improved incontinence cores. Incontinence scores did not improve in patients with neuropathy (n = 5) or patients (n = 5) with more than 10 years of symptoms.

Conclusion: Initial improvement of anal incontinence attenuated with time, in particular from short- to long-term follow-up. Patients with neuropathy experienced no improvement of incontinence. Beyond stoma formation, in compliant patients, one should consider other treatment options like sacral nerve stimulation and neosphincter formation.
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http://dx.doi.org/10.1007/s00384-021-04026-1DOI Listing
September 2021

Short- and long-term outcomes in patients operated with total minimally invasive esophagectomy for esophageal cancer.

Dis Esophagus 2021 Sep 7. Epub 2021 Sep 7.

Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.

At our hospital, the main treatment for resectable esophageal cancer (EC) has since 2013 been total minimally invasive esophagectomy (TMIE). The aim of this study was to present the short- and long-term results in patients operated with TMIE. This cross-sectional study includes all patients scheduled for TMIE from June 2013 to January 2016 at Oslo University Hospital. Data on morbidity, mortality, and survival were retrospectively collected from the patient administration system and the Norwegian Cause of Death Registry. Long-term postoperative health-related quality of life (HRQL) and level of dysphagia were assessed by patients completing the following questionaries: EORTC QLQ-OG25, QLQ-C30, and the Ogilvie grading scale. A total of 123 patients were included in this study with a median follow-up time of 58 months (1-88 months). 85% had adenocarcinoma, 15% squamous cell carcinoma. Seventeen patients (14%) had T1N0M0, 68 (55%) T2-T3N0M0, or T1-T2N1M0 and 38 (31%) had either T3N1M0 or T4anyNM0. Ninety-eight patients (80%) received neoadjuvant (radio)chemotherapy and 104 (85%) had R0 resection. Anastomotic leak rate and 90-days mortality were 14% and 2%, respectively. The 5-year overall survival was 53%. Patients with tumor free resection margins of >1 mm (R0) had a 5-year survival of 57%. Median 60 months (range 49-80) postoperatively the main symptoms reducing HRQL were anxiety, chough, insomnia, and reflux. Median Ogilvie score was 0 (0-1). In this study, we report relatively low mortality and good overall survival after TMIE for EC. Moreover, key symptoms reducing long-term HRQL were identified.
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http://dx.doi.org/10.1093/dote/doab061DOI Listing
September 2021

Very long-term outcome after resection rectopexy for internal rectal intussusception.

Scand J Gastroenterol 2021 Jan 30;56(1):122-127. Epub 2020 Nov 30.

Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.

Background: Both at short- and long-term follow-up we have reported major improvement of the symptom of constipation in patients treated with resection rectopexy for internal rectal intussusception (IRI). The aim was to study whether this improvement also persisted in a cohort of these patients after very long-term follow-up.

Methods: Observational and mainly prospective study of a cohort of 13 out of 48 patients with IRI who initially had ligament-preserving resection rectopexy with suture by laparoscopic ( = 11) or open ( = 2) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report and HRQL.

Results: Thirteen out of the 48 initial patients (27%) reported data at very long-term follow-up. Months from preoperatively to short-, long- and very long-term follow-up were median 6, 76 and 159, respectively. Corresponding mean (95% CI) constipation scores were 11.5 (8.3-14.7), 4.2 (1.7-6.6) ( < .001), 5.3 (3.6-7.0) ( < .05) and 13.6 (8.2-19.0). Number of constipated patients were (score ≥ 10) were 8, 1, 0, 1 and 9, respectively. Scores for anal incontinence were 6.1 (2.4-11.4), 5.8 (2.0-9.5), 4.9 (0.9-9.0) and 7.9 (4.3-11.5), respectively. HRQL life was reduced for bodily pain, social functioning, mental health and general health perception. Percentage patients reporting symptomatic improvement were 100, 70 and 53, respectively.

Conclusions: Patients with IRI have a symptomatic relief for more than 6 years after resection rectopexy. The operation did not inflict permanent patient sequela. Motivated patients must be informed about very long-term deterioration of symptomatic relief.
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http://dx.doi.org/10.1080/00365521.2020.1853221DOI Listing
January 2021

Outcome after endoscopic treatment for dysplasia and superficial esophageal cancer - a cohort study.

Scand J Gastroenterol 2020 Sep 4;55(9):1132-1138. Epub 2020 Aug 4.

Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.

Background: Dysplasia and superficial esophageal cancer should initially be treated endoscopically. Little is known about post-procedural health-related quality of life (HRQL). The aim of this study was to present our results with endoscopic treatment and post-procedural HRQL.

Materials And Methods: From June 2014 to December 2018, all patients treated with endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA) for low-grade dysplasia (LGD), high-grade dysplasia (HGD), T1a and a minority of patients with T1b at Oslo University Hospital were prospectively included. In June 2019, all patients alive were scored according to the Ogilvie dysphagia score as well as the QLQ-C30 and QLQ-OG25 for assessment of HRQL.

Results: Eighty-six patients were treated out of whom 22 (26%) had LGD, 44 (51%) HGD, 13 (15%) T1a, and six patients (7%) T1b. Histology revealed adenocarcinoma in 18 (21%) and squamous cell carcinoma in one (1%), respectively. The mean follow-up was 22.9 months. Tumor regression or downstaging was archived in 78% of the patients with LGD, 66% of patients with HGD and in 89% of patients with T1a/b. Five patients (6%) had esophagectomy. There were few and no serious complications. The 90-days mortality was 1%. Fifty-two patients (88%) experienced no dysphagia (Ogilvie score 0). There was no difference in 11 out of the 15 variables in QLQ-C30 when compared to a non-cancerous reference population.

Conclusions: Endoscopic treatment is safe and efficient for treatment of dysplasia and superficial esophageal cancer. The two-years post-procedural level of HRQL and dysphagia was satisfactory.
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http://dx.doi.org/10.1080/00365521.2020.1800813DOI Listing
September 2020

Can medicinal mushrooms have prophylactic or therapeutic effect against COVID-19 and its pneumonic superinfection and complicating inflammation?

Scand J Immunol 2021 Jan 29;93(1):e12937. Epub 2020 Jul 29.

Norwegian Institute of Public Health, Oslo, Norway.

Medicinal mushrooms have documented effects against different diseases, including infections and inflammatory disorders. The related Basidiomycota Agaricus blazei Murill (AbM), Hericium erinaceus (HE), and Grifola frondosa (GF) have been shown to exert antimicrobial activity against viral agents, Gram-positive and Gram-negative bacteria, and parasites in vitro and in vivo. Since the mechanism is immunomodulatory and not antibiotical, the mushrooms should be active against multi-drug resistant microbes as well. Moreover, since these Basidiomycota also have anti-inflammatory properties, they may be suited for treatment of the severe lung inflammation that often follows COVID-19 infection. An AbM-based mushroom extract (Andosan™), also containing HE and GF, has been shown to significantly reduce bacteraemia and increase survival in mice with pneumococcal sepsis, and to improve symptoms and quality of life in IBD patients via an anti-inflammatory effect. Hence, such mushroom extracts could have prophylactic or therapeutic effect against the pneumonic superinfection and severe lung inflammation that often complicates COVID-19 infection. Here, we review antimicrobial and anti-inflammatory properties of AbM, HE and GF mushrooms, which could be used for the battle against COVID-19.
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http://dx.doi.org/10.1111/sji.12937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404338PMC
January 2021

Antitumor, Anti-Inflammatory and Antiallergic Effects of Mushroom Extract and the Related Medicinal Basidiomycetes Mushrooms, and : A Review of Preclinical and Clinical Studies.

Nutrients 2020 May 8;12(5). Epub 2020 May 8.

Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway.

Since the 1980s, medicinal effects have been documented in scientific studies with the related mushrooms Murill (AbM), (HE) and (GF) from Brazilian and Eastern traditional medicine. Special focus has been on their antitumor effects, but the mushrooms' anti-inflammatory and antiallergic properties have also been investigated. The antitumor mechanisms were either direct tumor attack, e.g., apoptosis and metastatic suppression, or indirect defense, e.g., inhibited tumor neovascularization and T helper cell (Th) 1 immune response. The anti-inflammatory mechanisms were a reduction in proinflammatory cytokines, oxidative stress and changed gut microbiota, and the antiallergic mechanism was amelioration of a skewed Th1/Th2 balance. Since a predominant Th2 milieu is also found in cancer, which quite often is caused by a local chronic inflammation, the three conditions-tumor, inflammation and allergy-seem to be linked. Further mechanisms for HE were increased nerve and beneficial gut microbiota growth, and oxidative stress regulation. The medicinal mushrooms AbM, HE and GF appear to be safe, and can, in fact, increase longevity in animal models, possibly due to reduced tumorigenesis and oxidation. This article reviews preclinical and clinical findings with these mushrooms and the mechanisms behind them.
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http://dx.doi.org/10.3390/nu12051339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285126PMC
May 2020

Gastric adenocarcinoma and proximal polyposis of the stomach – a rare form of hereditary gastric cancer.

Tidsskr Nor Laegeforen 2020 05 4;140(7). Epub 2020 May 4.

Hereditary ventricular polyposis in the form of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) is a rare condition characterised by a typical distribution of polyps in the stomach and risk of gastric cancer at a young age. Prophylactic gastrectomy may be indicated. The condition is not thought to be associated with increased risk of colon cancer, but the evidence base is limited.
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http://dx.doi.org/10.4045/tidsskr.19.0480DOI Listing
May 2020

Nutritional status, sarcopenia, gastrointestinal symptoms and quality of life after gastrectomy for cancer - A cross-sectional pilot study.

Clin Nutr ESPEN 2020 06 14;37:195-201. Epub 2020 Mar 14.

Department of Pediatric and Gastrointestinal and Surgery, Oslo University Hospital, Ullevål, Norway; Institute of Clinical Medicine, University of Oslo, Norway.

Background And Aims: Gastrointestinal (GI) symptoms, malabsorption, reduced food intake and weight loss are common sequela of gastrectomy. This can result in malnutrition with a subsequent prolonged recovery, reduced physical functioning and deteriorated quality of life (QoL). Few studies have investigated the relationship between GI-symptoms, QoL and malnutrition in long-term survivors of gastric cancer. Therefore, we assess nutritional status, GI-symptoms and QoL 2-5 years after gastrectomy for malignancy.

Methods: A cross-sectional, pilot study was carried out in patients who underwent total or subtotal gastrectomy at Oslo University Hospital between 2012 and 2016, who had not experienced disease recurrence. Subjects above 85 years were excluded. The nutritional status of the patients fell into three groups by a score of subjective global assessment (SGA)-A, B, and C. Muscle mass was measured by body composition by bioelectrical impedance analysis and muscle strength was measured by handgrip strength (HGS). Dietary intake was assessed by repeated 24-h dietary recalls. GI-symptoms and QoL were assessed using GI-Symptom Rating Scale (GSRS) and the SF-36 questionnaire.

Results: 21 patients were included. Mean (SD) weight loss was 12.8% (11.6) from preoperative status to follow up. Percentage weight loss was larger after total gastrectomy compared with subtotal gastrectomy (17.9% (12.3) vs. 6.6% (7.1) (p = 0.03)). A low mean intake of energy and protein was reported compared to dietary recommendations for the general Nordic population and intake in a national dietary survey. All of the patients were classified as pre-sarcopenic, and 5% as sarcopenic. Persistent weight loss >10% was observed in 45% of the subjects and these were in risk of malnutrition. Subjects with malnutrition had higher GSRS score for the abdominal pain syndrome (p = 0.042) and lower SF-36 scores for bodily pain (p = 0.01) and vitality (p = 0.02) compared with those without malnutrition.

Conclusions: A high prevalence of weight loss, and pre-sarcopenia was observed. Malnutrition as assessed by SGA was associated with more GI-Symptoms and reduced QoL scores. Further studies with larger number of participants are needed to verify our findings.
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http://dx.doi.org/10.1016/j.clnesp.2020.03.001DOI Listing
June 2020

Long-term outcome in patients operated with hybrid esophagectomy for esophageal cancer - a cohort study.

Acta Oncol 2020 Jul 23;59(7):859-865. Epub 2020 Apr 23.

Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway.

Over the past two decades, hybrid and total minimally invasive esophagectomy for esophageal cancer (EC) has increasingly been implemented with the aim to improve morbidity, functional result and ultimately the prognosis in these patients. However, more results are warranted and in this single-center study we report long-time outcome in a cohort of cancer patients treated with hybrid esophagectomy (HE). Hundred and nine patients with EC operated with HE from November 2007 to June 2013 were included. Clinical, pathological and survival data were retrieved from the patient administration system and the Norwegian Cause of Death Registry. Patients alive were asked to fill out the Ogilvie dysphagia score, EORTC QLQ-C30 and EORTC QLQ-OG25. Survival was analyzed by Kaplan-Meier's method and prognostic factors by uni- and multivariable Cox regression analyses. Median overall follow-up time was 55 months (range 2-135) after R0-2 resection ( = 109) and 76 months (5-135) for R0 resection ( = 100). Five-year overall survival rate was 49% and 53%, respectively. Anastomotic leakage rate and 90-days mortality were 5% and 2%, respectively. Six patients (6%) had later surgery for metastases to mediastinum, hepatoduodenal ligament, brain, lung, liver or bladder median 26 months (4-51) after HE. Forty-one out of 51 patients alive (80%) filled out questionnaires after median 65.5 months (63-123) follow-up. All patients could eat normal food without ( = 37) or with ( = 4) problems. Nearly, half of the patients reported problems with reflux, one-third experienced fatigue and anxiety while one out of four had weight loss and episodes of dyspnea. In this patient series, HE offered low postoperative mortality and good overall long-term survival. Most survivors maintained good quality of life more than five years post treatment. There was a low rate of serious postoperative complications.
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http://dx.doi.org/10.1080/0284186X.2020.1750694DOI Listing
July 2020

NETs analysed by novel calprotectin-based assays in blood donors and patients with multiple myeloma or rheumatoid arthritis: A pilot study.

Scand J Immunol 2020 May 4;91(5):e12870. Epub 2020 Mar 4.

Department of Immunology and Transfusion Medicine, Oslo University Hospital (OUH), Oslo, Norway.

Two novel enzyme-linked immunosorbent assays (ELISAs), designed to detect complexes containing DNA, leucocyte calprotectin and S100A12 proteins, were generated for improved specificity and rapid measurement of neutrophil extracellular traps (NETs). The assays were applied on plasma and serum samples from blood donors for establishment of reference values, and from patients with multiple myeloma (MM) or rheumatoid arthritis (RA) in order to examine putatively increased values in the two different inflammatory conditions. Although NETs were hardly detectable in healthy individuals, NET levels were as expected highly and statistically significantly increased in RA patients. The detection of statistically significantly increased NET levels in MM is a novel finding.
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http://dx.doi.org/10.1111/sji.12870DOI Listing
May 2020

IgE-sensitization to food and inhalant allergens in IBD patients compared with normal blood donors at Oslo University Hospital, Norway.

Scand J Gastroenterol 2019 Sep 14;54(9):1107-1110. Epub 2019 Sep 14.

Institute of Clinical Medicine, University of Oslo , Oslo , Norway.

Crohn's disease (CD) and ulcerative colitis (UC) have been regarded as autoimmune Th-1/Th-17- and Th-2-associated conditions, respectively. The aim of the study was to examine possible differences in allergen sensitization between these diseases and relative to normal blood donors (BD). Plasma from 29 UC and 37 CD patients with moderate disease activity and 100 healthy age- and gender-matched BD, were analyzed for specific IgE to 22 food- and 28 inhalation allergens using EUROLINE atopy screen. There was significantly higher proportion of allergen sensitized patients in UC compared to BD. Corresponding mean percentages for UC, CD and BD were 8.5, 8.9 ( = .2) and 5.9 ( = .04). There was no intergroup difference in sensitization to food allergens. Most prominent result was the double level of sensitization to inhalants in CD (15%) compared to BD (8%) ( = .03). Overall highest levels of sensitization to inhalants were for grass pollens. Interestingly, the number of allergens ( = 50) the subjects were sensitized to, was significantly lower among UC ( = 20; 40%) ( = .0005) than CD ( = 31; 62%) and BD ( = 38; 76%). The percentage of individuals sensitized to inhalants in CD and to inhalants and foods in UC, were higher than corresponding results in BD. However, whereas allergen positive reactions in CD were comparable to those in BD, they were reduced in UC because of the few UC reactions to food allergens. This contrasts previous data and the study also points to sensitization to inhalants as a potential factor in the complex pathogenesis of IBD.
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http://dx.doi.org/10.1080/00365521.2019.1663445DOI Listing
September 2019

Outcome after iatrogenic esophageal perforation.

Scand J Gastroenterol 2019 Feb 11;54(2):140-144. Epub 2019 Mar 11.

c Department of Pediatric and Gastrointestinal Surgery , Oslo University Hospital, Ullevål , Oslo , Norway.

Objectives: Iatrogenic perforations are the most common cause of esophageal perforation. We present our experience mainly based on a non-operative treatment approach as well as long-term outcome in these patients.

Materials And Methods: Twenty-one patients were treated for iatrogenic esophageal perforation at Oslo University Hospital, Ullevål from February 2007 to March 2014. The etiology of perforation was dilation of benign stricture in eight patients, either dilation, stenting or stent removal in four with malignant stenosis, during diagnostic endoscopy in four, removal of foreign body in two and by other causes in three patients, respectively. After median 82 months, 10 patients alive (47.6%) were sent questionnaires about dysphagia, HRQoL and fatigue.

Results: Median age at time of treatment was 66 years. Median in-hospital stay and mortality were 10.5 days and 4.8%, respectively. Initial treatment in 15 patients (71.4%) was non-surgical of whom one needed delayed debridement for pleural empyema. Initial treatment in six patients (28.6%) was surgical of whom three needed delayed stenting. Altogether 14 patients (66.7%) were stented. Eight (57.1%) had restenting. Median number of stents used was 1 (1-4). The stents were removed after median 36 days. The perforations healed after 2.5 months. After median 82 months, the patients reported reduced HRQoL. There was no significant difference regarding level of dysphagia and fatigue.

Conclusions: We report satisfactorily short-term and long-term results of iatrogenic esophageal perforations. Mortality was low and HRQoL was deteriorated. Dysphagia and fatigue were comparable to a reference population.
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http://dx.doi.org/10.1080/00365521.2019.1575464DOI Listing
February 2019

Laparascopic resection for gastric cancer at Oslo University Hospital, Ullevål 2015–18.

Tidsskr Nor Laegeforen 2018 11 5;138(18). Epub 2018 Nov 5.

Background: We wished to assess our experiences with laparoscopy used in curative resection for gastric cancer.

Material And Method: All patients with gastric cancer who underwent curative-intent surgery, irrespective of access, in the period 1 May 2015-28 February 2018 at Oslo University Hospital Ullevål were included. The patient care pathway and oncological results were registered continuously and analysed retrospectively.

Results: A total of 93 patients underwent surgery, 48 of whom were women. Median age was 73 (32-89) years, and 16 patients were 80 years of age or above. The duration of the procedure was 265 (125-644) minutes. Altogether seven patients underwent laparotomy, one was planned and six were converted to open surgery. Standardised lymph node dissection was performed in 88 patients. Complications were recorded in 48 patients, of which 11 were serious. A total of six patients had anastomotic leakage. Three died within 30 days/during hospitalisation. Postoperative hospitalisation was 12 (5-78) days. A total of 86 patients underwent radical surgery, five had tumour infiltration in the resection margins, and two had indeterminate resection status. The median number of lymph nodes identified was 18 (0-53). Tumours were locally advanced in 56 patients.

Interpretation: Laparoscopic gastric resection with standardised lymph node dissection can be performed in most patients with gastric cancer who undergo curative-intent surgery. The method has become standard in our department.
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http://dx.doi.org/10.4045/tidsskr.18.0404DOI Listing
November 2018

Outcome after accidental food bolus-induced esophageal perforation.

Scand J Gastroenterol 2018 Aug;53(8):905-909

c Department of Pediatric and Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway.

Objectives: Food bolus-induced esophageal perforation is much more seldom than iatrogenic and emetic esophageal rupture. We present results from a non-operative treatment approach as well as long-term functional outcome.

Materials And Methods: Medical records of 10 consecutive patients with food bolus-induced esophageal perforation from October 2007 to May 2015 were retrospectively registered in a database. Six patients developed perforation related to endoscopic removal of impacted food, and four during esophageal passage of bone, meat or bread. Treatment was sealing the perforation by stenting (n = 7) with (n = 4) or without (n = 3) chest tube drainage, chest tube drainage (n = 1), observation (n = 1) and gastroesophageal resection (n = 1) because of concomitant emesis of gastric effluent. After median 51 months nine patients reported about dysphagia, fatigue and health-related quality of life.

Results: Ten patients aged median 62.5 years (range 30-85) stayed in our hospital for 12 days (5-68 days). There was no treatment-related mortality. Nine patients were alive 63 months (18-126) after perforation. Five needed restenting (leakage, migration, impacted stent), two had drainage of a mediastinal abscess, one patient developed a transient esophagobronchial fistula. Dysphagia score was 0 (0-1). One patient developed dysphagia for some solid food. Scores for fatigue and HRQoL was similar to a Norwegian reference population.

Conclusion: Treatment mainly with a non-operative approach occurred without mortality. Complications were handled by restenting and abscess drainage. Functional result for dysphagia was excellent. Interesting results on fatigue and HRQoL must be interpreted with caution because of a limited patient material.
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http://dx.doi.org/10.1080/00365521.2018.1495760DOI Listing
August 2018

Management of gastric conduit retention following hybrid and minimally invasive esophagectomy for esophageal cancer: Two retrospective case series.

Int J Surg Case Rep 2017 24;41:505-510. Epub 2017 Nov 24.

Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Ullevål, P. O. Box 4950 Nydalen, Oslo, Norway. Electronic address:

Introduction: Following esophagectomy about 5% of patients experience long-term gastric conduit retention. We report two patients with surgical correction for this problematic condition. This case series is a retrospective, non-consecutive single center report.

Presentation Of Cases: A slender female aged 76 (patient 1) and an obese man aged 69 (patient 2) with esophageal cancer, underwent hybrid and total minimally invasive Ivor-Lewis esophagectomy, respectively. The conduit was tubularized, and the stapled anastomosis located above carina. The crura were divided in patient 1. Contrast enema revealed a straight (patient 1) or redundant (patient 2) thoracic conduit. Conduit retention in patient 1 began after 47 months. After 61 months reoperation was performed with open thoracoabdominal access for mobilization, abdominal reduction and diaphragmatic suture fixation of the herniated conduit. Symptoms improved and oral nutrition is still sufficient after 8 months.Patient 2 had clinically significant retention after 15 months, despite using pyloric Botox injection and expandable metal stenting. At laparoscopic reoperation after 27 months a partial conduit mobilization and refixation were unsuccessful, but an accidental colonic hiatal hernia was taken down. After 28 months a second reoperation was performed, similar to patient 1. Fifteen months afterwards the patient still ate sufficiently, but a limited double reherniation had occurred.

Discussion: Long-term retention post-esophagectomy often start with an initial redundant conduit, that can increase from food-induced stretching and declive emptying against gravity. A wide hiatal opening probably also predispose to conduital herniation.

Conclusions: Conduit retention improved after mobilization, reduction and its hiatal fixation. A too wide or narrow hiatal opening must be avoided to prevent herniation.
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http://dx.doi.org/10.1016/j.ijscr.2017.11.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723268PMC
November 2017

Outcome after stenting and débridement for spontaneous esophageal rupture.

Scand J Gastroenterol 2018 04 9;53(4):398-402. Epub 2018 Mar 9.

c Department of Pediatric and Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway.

Objectives: Surgical repair has been the most common treatment of esophageal effort rupture (Boerhaave syndrome). Stent-induced sealing of the perforation has increasingly been used with promising results. We present our eight years´ experience with stent-based and organ-preserving treatment.

Materials And Methods: Medical records of 15 consecutive patients with Boerhaave syndrome from February 2007 to May 2015 were retrospectively registered in a database. Treatment was sealing of the perforation by stenting, chest tube drainage and débridement of the contaminated thorax. After median 25 months nine out of 10 patients responded to questions on fatigue and Ogilvie's dysphagia score.

Results: Fifteen patients, aged median 67.5 years (range 39-88), had a primary hospital stay of 20 days (range 1-80 days). Overall in-hospital mortality was 13%. Observation time was 44 months (range 0-87) and 10 patients were alive of August 2017. Ten patients (67%) needed surgical chest débridement. Five patients (33%) were restented for leakage, migration and for stent removal. Eleven patients (73%) had complications, which included pleural empyema (n = 4), fatal aortic bleeding, lung arterial bleeding, lung embolism, drain-induced lung laceration and respiratory failure. Dysphagia score was low (median 0.5) meaning that they were able to feed themselves. Total fatigue score (mean 14.6) was slightly increased (p = .05) compared with a reference population.

Conclusions: The mortality rate after initial stenting of effort rupture seems to be comparable to standard surgical repair. Most patients required further intervention, either by restenting and/or surgical débridement. The functional result in these patients was satisfactory.
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http://dx.doi.org/10.1080/00365521.2018.1448886DOI Listing
April 2018

Improved treatment decisions in patients with esophageal cancer.

Acta Oncol 2017 Oct 7;56(10):1286-1294. Epub 2017 Jul 7.

d Research Support Services , Oslo University Hospital , Norway.

Background: Patients with esophageal cancer seldom achieve long-term survival. This prospective cohort study investigated the selection of patients likely to benefit from curative treatment and whether information on patients' health-related quality of life (HRQL) would assist treatment decisions in the multidisciplinary team.

Methods: Consecutive patients completed HRQL assessments and clinical data were collected before start of treatment. Logistic regression analyses identified clinical factors associated with treatment intent in patients with stage-III disease. Kaplan-Meier method was used for survival analyses and Cox proportional hazards models were used to assess the impact of clinical factors and HRQL on survival in patients planned for curative treatment.

Results: Patients with curative treatment intent (n = 90) were younger, had better WHO performance status and less fatigue than patients with palliative treatment intent (n = 89). Median survival for the total cohort (n = 179) and patients with palliative or curative treatment intent was nine, five and 19 months, respectively. In multivariate Cox regression analyses, performance status (0-1 favorable) and comorbidity (ASA I favorable) were factors of importance for survival, whereas measures of HRQL were not.

Conclusions: Patients performance status and comorbidity must be considered in addition to stage of disease to avoid extensive curative treatment in patients with short life expectancy. This study did not provide evidence to support that information on patients HRQL adds value to the multidisciplinary team's treatment decision process.
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http://dx.doi.org/10.1080/0284186X.2017.1346379DOI Listing
October 2017

Effect of the Medicinal Agaricus blazei Murill-Based Mushroom Extract, AndoSanTM, on Symptoms, Fatigue and Quality of Life in Patients with Crohn's Disease in a Randomized Single-Blinded Placebo Controlled Study.

PLoS One 2016 14;11(7):e0159288. Epub 2016 Jul 14.

Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.

Background: Ingestion of AndoSanTM, based on the mushroom Agaricus blazei Murill, has previously shown an anti-inflammatory effect through reduction of pro-inflammatory cytokines in healthy individuals and patients with Crohn's disease (CD). In this randomized single-blinded placebo-controlled study we examined whether intake of AndoSanTM also resulted in clinical effects.

Methods And Findings: 50 patients with symptomatic CD were randomized for oral daily consumption of AndoSanTM or placebo for a 21-day experimental period, in this per-protocol study. Patients reported validated scores for symptoms, fatigue and health related quality of life (HRQoL) at days 0, 14 and 21. Fecal calprotectin and general blood parameters were also analyzed. In the AndoSanTM group (n = 25) symptoms improved from baseline (day 0) to days 14 and 21, with respective mean scores (95% CI) of 5.52 (4.64-6.40), 4.48 (3.69-5.27) and 4.08 (3.22-4.94) (p<0,001). We found significant improvements in symptom score for both genders in the AndoSanTM group, and no significant changes in the placebo (n = 25) group. There were however no significant differences between the groups (p = 0.106), although a marginal effect in symptom score for men (p = 0.054). There were comparable improvements in physical, mental and total fatigue for both groups. HRQoL versus baseline were at day 21 improved for bodily pain and vitality in the AndoSanTM group and for vitality and social functioning in the placebo group. No crucial changes in general blood samples and fecal calprotectin were detected.

Conclusions: The results from this single-blinded randomized clinical trial shows significant improvement on symptoms, for both genders, in the AndoSanTM group, but no significant differences between the study groups. The results on fatigue, HRQoL, fecal calprotectin and blood samples were quite similar compared with placebo. The patients did not report any harms or unintended effects of AndoSanTM. CD patients with mild to moderate symptoms may have beneficiary effects of AndoSanTM as a safe supplement in addition to conventional medication.

Trial Registration: ClinicalTrials.gov NCT01496053.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159288PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944955PMC
July 2017

Resection for oesophageal cancer - complications and survival.

Tidsskr Nor Laegeforen 2016 May 24;136(9):809-13. Epub 2016 May 24.

Avdeling for gastro- og barnekirurgi Oslo universitetssykehus, Ullevål og Institutt for klinisk medisin Universitetet i Oslo.

BACKGROUND Surgery is considered necessary to achieve a cure for oesophageal cancer. Minimally invasive oesophageal resection is increasingly performed with the aim of reducing the number of complications compared with open surgery. The purpose of this study was to investigate postoperative complications, mortality and long-term survival following hybrid oesophageal resection by laparoscopy and thoracotomy.MATERIAL AND METHOD Patients with oesophageal cancer who underwent hybrid resection with curative intent at Oslo University Hospital Ullevål from 1 November 2007 to 1 June 2013 were included (n = 109). Complications were graded according to the Clavien-Dindo classification and survival figures were recorded.RESULTS Median age was 65 years, 79 % were men. Altogether 118 complications were recorded in 70 patients (64.2 %). Distribution of complications was 1.8 % for stage I, 29.4 % for stage II, 22.1 % for stage III and 11.0 % for stage IV. Anastomotic leakage occurred in 4.6 %. There was no postoperative mortality. The proportion of R0 resections with microscopic radicality was 91 % (n = 100). For the entire patient population, the estimated 5-year survival rate was 48 % (95 % CI 36 - 60 %), for R0 resection 51 % (38 - 63 %) and for R1-2 resection 0 %. Estimated median survival with R0-2, R0 and R1-2 resection was 55, 55 and 10 months (0 - 28 months), respectively. R status and stage had a significant bearing on survival.INTERPRETATION There was a low percentage of serious complications, no mortality and few anastomotic leakages after hybrid resection for oesophageal cancer. The 5-year survival rate was good.
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http://dx.doi.org/10.4045/tidsskr.15.1136DOI Listing
May 2016

Effect of a Medicinal Agaricus blazei Murill-Based Mushroom Extract, AndoSan™, on Symptoms, Fatigue and Quality of Life in Patients with Ulcerative Colitis in a Randomized Single-Blinded Placebo Controlled Study.

PLoS One 2016 2;11(3):e0150191. Epub 2016 Mar 2.

Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Norway.

Background: Ingestion of AndoSan™, based on the mushroom Agaricus blazei Murill, has previously been shown to exhibit anti-inflammatory effects because of reduction of pro-inflammatory cytokines in healthy individuals and patients with ulcerative colitis. In this randomized single-blinded placebo controlled study we examined whether intake of AndoSan™ also resulted in clinical effects.

Methods And Findings: 50 patients with symptomatic ulcerative colitis were block-randomized and blinded for oral daily intake of AndoSan™ or placebo for the 21 days' experimental period. The patients reported scores for symptoms, fatigue and health related quality of life (HRQoL) at days 0, 14 and 21. Fecal calprotectin and general blood parameters were also analyzed. In the AndoSan™ group (n = 24) symptoms improved from baseline (day 0) to days 14 and 21, with respective mean scores (95% CI) of 5.88 (4.92-6.83), 4.71 (3.90-5.52) (p = 0.002) and 4.50 (3.70-5.30) (p = 0.001). Corresponding improved mean scores (±SD) for total fatigue were 16.6 (5.59), 14.1 (4.50) (p = 0.001) and 15.1 (4.09) (p = 0.023). These scores in the placebo group (n = 26) were not improved. When comparing the two study groups using mixed model statistics, we found significant better scores for the AndoSan™-patients. HRQoL for dimensions bodily pain, vitality, social functioning and mental health improved in the AndoSan™ group. There were no alterations in general blood samples and fecal calprotectin.

Conclusions: Beneficiary effects on symptoms, fatigue and HRQoL from AndoSan™ consumption were demonstrated in this per-protocol study, supporting its use as a supplement to conventional medication for patients with mild to moderate symptoms from ulcerative colitis. The patients did not report any harms or unintended effects of AndoSan™ in this study.

Trial Registration: ClinicalTrials.gov NCT01496053.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150191PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774976PMC
July 2016

Gastrobronchial fistula following minimally invasive esophagectomy for esophageal cancer in a patient with myotonic dystrophy: Case report.

Int J Surg Case Rep 2015 21;17:31-5. Epub 2015 Oct 21.

Departments of Lung Medicine, Oso University Hospital, Ullevål, P. O. Box 4950 Nydalen, Oslo, Norway. Electronic address:

Introduction: Myotonic dystrophies are inherited multisystemic diseases characterized by musculopathy, cardiac arrythmias and cognitive disorders. These patients are at increased risk for fatal post-surgical complications from pulmonary hypoventilation. We present a case with myotonic dystrophy and esophageal cancer who had a minimally invasive esophagectomy complicated with gastrobronchial fistulisation.

Presentation Of Case: A 44-year-old male with myotonic dystrophy type 1 and esophageal cancer had a minimally invasive esophagectomy performed instead of open surgery in order to reduce the risk for pulmonary complications. At day 15 respiratory failure occurred from a gastrobronchial fistula between the right intermediary bronchus (defect 7-8mm) and the esophagogastric anastomosis (defect 10mm). In order to minimize large leakage of air into the gastric conduit the anastomosis was stented and ventilation maintained at low airway pressures. His general condition improved and allowed extubation at day 29 and stent removal at day 35. Bronchoscopy confirmed that the fistula was healed. The patient was discharged from hospital at day 37 without further complications.

Discussion: The fistula was probably caused by bronchial necrosis from thermal injury during close dissection using the Ligasure instrument. Fistula treatment by non-surgical intervention was considered safer than surgery which could be followed by potentially life-threatening respiratory complications. Indications for stenting of gastrobronchial fistulas will be discussed.

Conclusions: Minimally invasive esophagectomy was performed instead of open surgery in a myotonic dystrophy patient as these patients are particularly vulnerable to respiratory complications. Gastrobronchial fistula, a major complication, was safely treated by stenting and low airway pressure ventilation.
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http://dx.doi.org/10.1016/j.ijscr.2015.10.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701820PMC
January 2016

Intestinal PTGS2 mRNA levels, PTGS2 gene polymorphisms, and colorectal carcinogenesis.

PLoS One 2014 28;9(8):e105254. Epub 2014 Aug 28.

Organ Center, Hospital of Southern Jutland, Aabenraa, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Medical Department, Regional Hospital Viborg, Viborg, Denmark.

Background & Aims: Inflammation is a major risk factor for development of colorectal cancer (CRC). Prostaglandin synthase cyclooxygenase-2 (COX-2) encoded by the PTGS2 gene is the rate limiting enzyme in prostaglandin synthesis and therefore plays a distinct role as regulator of inflammation.

Methods: PTGS2 mRNA levels were determined in intestinal tissues from 85 intestinal adenoma cases, 115 CRC cases, and 17 healthy controls. The functional PTGS2 polymorphisms A-1195G (rs689466), G-765C (rs20417), T8473C (rs5275) were assessed in 200 CRC cases, 991 adenoma cases and 399 controls from the Norwegian KAM cohort.

Results: PTGS2 mRNA levels were higher in mild/moderate adenoma tissue compared to morphologically normal tissue from the same individual (P<0.0001) and (P<0.035) and compared to mucosa from healthy individuals (P<0.0039) and (P<0.0027), respectively. In CRC patients, PTGS2 mRNA levels were 8-9 times higher both in morphologically normal tissue and in cancer tissue, compared to healthy individuals (P<0.0001). PTGS2 A-1195G variant allele carriers were at reduced risk of CRC (odds ratio (OR) = 0.52, 95% confidence interval (95% CI): 0.28-0.99, P = 0.047). Homozygous carriers of the haplotype encompassing the A-1195G and G-765C wild type alleles and the T8473C variant allele (PTGS2 AGC) were at increased risk of CRC as compared to homozygous carriers of the PTGS2 AGT (A-1195G, G-765C, T8473C) haplotype (OR = 5.37, 95% CI: 1.40-20.5, P = 0.014). No association between the investigated polymorphisms and PTGS2 mRNA levels could be detected.

Conclusion: High intestinal PTGS2 mRNA level is an early event in colorectal cancer development as it occurs already in mild/moderate dysplasia. PTGS2 polymorphisms that have been associated with altered PTGS2 mRNA levels/COX-2 activity in some studies, although not the present study, were associated with colorectal cancer risk. Thus, both PTGS2 polymorphisms and PTGS2 mRNA levels may provide information regarding CRC risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105254PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148233PMC
October 2015

Surgical treatment of epiphrenic oesophageal diverticulum.

Tidsskr Nor Laegeforen 2014 May 27;134(10):1047-50. Epub 2014 May 27.

Avdeling for gastro- og barnekirurgi Oslo universitetssykehus, Ullevål.

Background: Epiphrenic diverticula occur in the lowermost 10 cm of the oesophagus. The main symptoms are dysphagia, regurgitation and pain when swallowing food. The main purpose of the survey was to evaluate the department's results for surgical treatment of this rare and distressing condition.

Material And Method: In the period 2002-2012, eleven patients (nine men) underwent surgery for an oesophageal diverticulum consisting of excision (n = 8), myotomy of the lower oesophageal sphincter and Dor fundoplication (n = 2) or all these procedures (n = 1). Two of them were transferred from other hospitals because of complications. Details of pre-operative symptoms and post-operative complications were retrieved retrospectively from patient records. Ten patients who agreed to take part in a retrospective survey responded to a questionnaire a median of 27.5 months (range of 2-105 months) after surgery.

Results: There were no fatalities as a result of the treatment. Three patients developed leakage after the diverticulum excision, two of whom required reoperation. The patients experienced considerable symptomatic improvement. According to the retrospective survey, eight of the nine patients with pre-operative dysphagia no longer had it. Four of seven with regurgitation, and all five patients who experienced pain in connection with swallowing, experienced post-operative improvement. The patients reported their condition as completely well (n = 5) or improved (n = 5) after the operation. One patient who had undergone reoperation for leakage and oesophageal mediastinal fistula did not consent to further surgery.

Interpretation: Most patients who underwent surgery for epiphrenic oesophageal diverticulum in our department experienced symptomatic improvement after surgery.
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http://dx.doi.org/10.4045/tidsskr.13.1336DOI Listing
May 2014

Iatrogenic esophago-tracheal fistula: challenges in diagnosis and management.

World J Gastroenterol 2013 Jan;19(4):594-6

Department of Gastroenterology/Internal Medicine, Innlandet Hospital Trust, 2819 Gjøvik, Norway.

Esophageo-tracheal fistula is a rare condition, and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation. A case where a wrapped tablet produced a fistula between the esophagus and trachea is described. The patient is a male born in 1938 who swallowed a tablet without unwrapping it. The patient was treated with self-expanding metal stents (SEMS), but closure of the fistula was not achieved. Different examinations and treatment options are discussed. Surgical treatment for this condition has demonstrated considerable mortality and morbidity. In some cases closure of the fistula can be achieved by use of SEMS. Although we advise treatment of such cases with SEMS, in some cases treatment with stents will prove troublesome and the risk/benefit analysis will have to be reevaluated.
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http://dx.doi.org/10.3748/wjg.v19.i4.594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558588PMC
January 2013

Long-term outcome after resection rectopexy for internal rectal intussusception.

ISRN Gastroenterol 2012 30;2012:824671. Epub 2012 Dec 30.

Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Ulleval, Kirkeveien 166, 0407 Oslo, Norway ; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.

Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4-7.0), 4.0 (2.4-5.7), and 4.1 (2.3-5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.
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http://dx.doi.org/10.5402/2012/824671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546480PMC
January 2013

Human monocyte responses to lipopolysaccharide and 9-cis retinoic acid after laparoscopic surgery for colon cancer.

Scand J Clin Lab Invest 2012 Dec 24;72(8):593-601. Epub 2012 Oct 24.

Institute for Surgical Research, Oslo University Hospital Rikshospitalet HF, Oslo, Norway.

Surgery, even modern minimal invasive laparoscopic surgery, induces an initial inflammatory and acute phase response which is followed by a period of immunosuppression rendering surgical patients more susceptible to infection. Here, we aimed to study changes in monocyte inflammatory responses and inflammatory modulation mechanisms following laparoscopic colorectal surgery for colon cancer. Blood samples were collected from 19 colon cancer patients before, directly after and daily for 3 days following surgery. Blood cells were exposed ex vivo to bacterial lipopolysaccharide (LPS) or the inflammatory modulator 9-cis retinoic acid (9cisRA). In blood samples taken prior to surgery, we found significant pro-inflammatory responses to LPS, indicating classical monocyte activation. Directly after surgery, LPS induced significantly less early pro-inflammatory cytokines and monocyte/granulocyte-attracting chemokines. The LPS-mediated release of interleukin (IL)-1β was still significantly attenuated 3 days after surgery. In patient monocytes collected after surgery, we found increased levels of suppressors of cytokine signaling (SOCS)1 and SOCS3 mRNA, reported to be associated with polarization towards resolving macrophages. The retinoic acid isomer 9cisRA, reported to attenuate LPS-mediated inflammatory responses and alter chemokine responses in cultured monocytes, had a similar effect in patient blood. Three days after surgery, 9cisRA still attenuated pro-inflammatory responses, but the induction of monocyte chemoattractive protein (MCP)-1/CCL2 mRNA in monocytes was reduced. This study indicates changes in monocyte responses that last for at least 3 days after laparoscopic surgery.
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http://dx.doi.org/10.3109/00365513.2012.721520DOI Listing
December 2012

Effect of AndoSan™ on expression of adhesion molecules and production of reactive oxygen species in human monocytes and granulocytes in vivo.

Scand J Gastroenterol 2012 Sep 8;47(8-9):984-92. Epub 2012 May 8.

Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway.

Background: Oral intake (60 ml daily) over 12 days in eight healthy volunteers of an immunostimulatory extract based on the medicinal mushroom Agaricus blazei Murill (AbM (AndoSan™)), reduced the monocyte and granulocyte release of mainly proinflammatory cytokines in vivo, suggesting an anti-inflammatory effect. In this foremost in vivo study, the aim was to examine the effect of such AndoSan™ consumption on the expression of adhesion molecules CD11b, CD11c and CD62L and production of reactive oxygen species (ROS) in leukocytes.

Methodology/principal Findings: As shown by flow cytometry, there was a significant increase of CD62L expression on monocytes and granulocytes from before (day 0) compared with 12 days after daily AndoSan™ consumption. However, only minor alterations and no clear trend in the expression of CD11b and CD11c were detected. Intracellular ROS (mainly superoxide ion) were significantly reduced in these cells from days 0 to 12.

Conclusions/significance: These results support that oral intake of AndoSan™ exhibits an anti-inflammatory effect in humans in vivo.
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http://dx.doi.org/10.3109/00365521.2012.660544DOI Listing
September 2012

The Mushroom Agaricus blazei Murill Elicits Medicinal Effects on Tumor, Infection, Allergy, and Inflammation through Its Modulation of Innate Immunity and Amelioration of Th1/Th2 Imbalance and Inflammation.

Adv Pharmacol Sci 2011 6;2011:157015. Epub 2011 Sep 6.

Department of Cellular Therapy, The Norwegian Radium Hospital, Oslo University Hospital, Ullernchaussen 70, 0130 Oslo, Norway.

The medicinal mushroom Agaricus blazei Murill from the Brazilian rain forest has been used in traditional medicine and as health food for the prevention of a range of diseases, including infection, allergy, and cancer. Other scientists and we have examined whether there is scientific evidence behind such postulations. Agaricus blazei M is rich in the immunomodulating polysaccharides, β-glucans, and has been shown to have antitumor, anti-infection, and antiallergic/-asthmatic properties in mouse models, in addition to anti-inflammatory effects in inflammatory bowel disease patients. These effects are mediated through the mushroom's stimulation of innate immune cells, such as monocytes, NK cells, and dendritic cells, and the amelioration of a skewed Th1/Th2 balance and inflammation.
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http://dx.doi.org/10.1155/2011/157015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168293PMC
November 2011

The level of claudin-7 is reduced as an early event in colorectal carcinogenesis.

BMC Cancer 2011 Feb 10;11:65. Epub 2011 Feb 10.

Department of Cellular and Molecular Medicine, Faculty of Health Science, University of Copenhagen, Denmark.

Background: Compromised epithelial barriers are found in dysplastic tissue of the gastrointestinal tract. Claudins are transmembrane proteins important for tight junctions. Claudins regulate the paracellular transport and are crucial for maintaining a functional epithelial barrier. Down-regulation of the oncogenic serine protease, matriptase, induces leakiness in epithelial barriers both in vivo and in vitro. We found in an in-silico search tight co-regulation between matriptase and claudin-7 expression. We have previously shown that the matriptase expression level decreases during colorectal carcinogenesis. In the present study we investigated whether claudin-7 expression is likewise decreased during colorectal carcinogenesis, thereby causing or contributing to the compromised epithelial leakiness of dysplastic tissue.

Methods: The mRNA level of claudin-7 (CLDN7) was determined in samples from 18 healthy individuals, 100 individuals with dysplasia and 121 colorectal cancer patients using quantitative real time RT-PCR. In addition, immunohistochemical stainings were performed on colorectal adenomas and carcinomas, to confirm the mRNA findings.

Results: A 2.7-fold reduction in the claudin-7 mRNA level was found when comparing the biopsies from healthy individuals with the biopsies of carcinomas (p < 0.001). Reductions in the claudin-7 mRNA levels were also detected in mild/moderate dysplasia (p < 0.001), severe dysplasia (p < 0.01) and carcinomas (p < 0.01), compared to a control sample from the same individual. The decrease at mRNA level was confirmed at the protein level by immunohistochemical stainings.

Conclusions: Our results show that the claudin-7 mRNA level is decreased already as an early event in colorectal carcinogenesis, probably contributing to the compromised epithelial barrier in adenomas.
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http://dx.doi.org/10.1186/1471-2407-11-65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045986PMC
February 2011

Short- and long-term results of secondary anterior sphincteroplasty in 33 patients with obstetric injury.

Acta Obstet Gynecol Scand 2010 Nov;89(11):1466-72

Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Norway.

Objective: To study short- and long-term improvement in obstetric anal incontinence after secondary overlapping sphincteroplasty and repeat repairs.

Design: A prospective analysis based on incontinence scores and patient satisfaction.

Setting: Department of Gastroenterological Surgery, Oslo University Hospital, a tertiary unit also dealing with sphincter repair.

Population: Of 40 obstetric patients operated consecutively from February 1996 to April 2004, 33 (83%) patients with median age of 36 years were eligible for evaluation.

Methods: Wexner's and St. Mark's incontinence score, clinical examination, anal ultrasonography and manometry, and neurophysiological examination when indicated. Patient satisfaction to treatment was recorded. The patients had anterior overlapping sphincteroplasty. Five had repeat operations, four sphincteroplasty and two post-anal repair.

Main Outcome Measures: Anal incontinence, patient satisfaction.

Results: The 33 patients were examined after median 7 (range 2-62) months and 103 (62-162) months. Median incontinence scores preoperatively and after short- and long-term follow-up were 12 (5-20), 7 (5-20) (p < 0.01) and 9 (0-18) (p < 0.05), respectively. Three patients (9%) had normalized anal incontinence (score ≤1) after short- and long-term follow-up. Corresponding numbers for improved anal incontinence were 22 (67%) and 16 (49%), respectively. Improvement in incontinence scores and patients' satisfaction were concordant. Symptom duration (n = 7), pudendal neuropathy (n = 6), repeat repair (n = 5) and instrument delivery (n = 3) were associated with adverse outcome.

Conclusions: Improvement in anal incontinence at short-term follow-up is attenuated at long-term follow-up. Stoma formation, sacral nerve stimulation and neo-sphincter formation must be considered in compliant patients.
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http://dx.doi.org/10.3109/00016349.2010.519019DOI Listing
November 2010
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