| 1. |
- Ahlström, Håkan, et al.
(författare)
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Inoperable biliary obstruction treated with percutaneously placed endoprosthesis
- 1986
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 152, s. 301-303
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Tidskriftsartikel (refereegranskat)abstract
- Biliary obstruction was treated with endoprosthetic drainage in 30 patients with pancreatic, 10 with gallbladder and 27 with biliary duct cancer, and 13 of the patients received more than one endoprosthesis. The median survival time in the respective cancer groups was 12, 10 and 9 weeks, including 6, 3 and 4 weeks spent in the patients' own homes. The patients with multiple endoprostheses had 24 weeks median survival with 22 weeks at home. Another patient, with a medically treated malignant endocrine tumour of the pancreas, lived for more than 3 years after biliary tract stenting. Complications associated with insertion of endoprosthesis were few, and clinical cholangitis occurred in seven cases. For individual patients it is difficult to predict the benefit of endoprosthetic drainage, but the procedure seems questionable if the predrainage bilirubin level is very high.
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| 2. |
- Alston-Smith, J, et al.
(författare)
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Endotoxin, epinephrine, glucagon, insulin and calcium ionophore A23187 modulation of pyruvate kinase activity in cultured rat hepatocytes
- 1990
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Ingår i: Acta chirurgica Scandinavica. - : Taylor & Francis. ; 156:10, s. 677-681, s. 677-681
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Tidskriftsartikel (refereegranskat)abstract
- Altered glucose metabolism is one of the commonly observed sequelae of sepsis and septic shock. The present investigation was undertaken to determine the role of endotoxin (ET) upon hepatocyte glucoregulation, by measuring the activity of pyruvate kinase (PK), a key glycolytic enzyme. Hepatocytes were exposed to endotoxin concentrations known to occur in vivo during sepsis, i.e., from 1 X 10(-14) to 1 X 10(-8) g/ml. The alteration of the enzyme activities after addition of epinephrine, glucagon, insulin and calcium ionophore A23187 with and without ET preincubation were also examined. ET alone decreased the PK activity by 12% at all concentrations tested. The basal inhibition of the enzyme caused by epinephrine (-48%) was partially blocked by ET preincubation above 1 X 10(-10) g/ml. There were no ET-(glucagon, calcium ionophore, insulin) interaction. These in vitro results do not support pyruvate kinase as a site of hepatic enzyme regulation defect in endotoxaemia.
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| 3. |
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| 4. |
- Arnbjornsson, E.
(författare)
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Acute appendicitis risk in various phases of the menstrual cycle
- 1983
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 149:6, s. 603-605
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Tidskriftsartikel (refereegranskat)abstract
- The significantly different age-specific incidence of acute appendicitis between males and females in the second, third and fourth decades of life led to a study of the frequency of acute appendicitis and the degree of appendiceal inflammation found at operation in the different phases of the menstrual cycle. The frequency of acute appendicitis was almost twice as high in the luteal phase as in the other half of the menstrual cycle. The proportion of gangrenous, perforated or normal appendices was significantly higher in the menstrual and follicular phases of the cycle. The study indicated that the female sex hormones may play an important etiologic part in acute appendicitis or may influence the inflammatory process in the appendix.
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| 5. |
- Arnbjornsson, E., et al.
(författare)
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Decreasing incidence of acute appendicitis, with special reference to the consumption of dietary fiber
- 1982
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 148:5, s. 461-464
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of acute appendicitis and the total number of appendectomies performed in the adult population admitted to our medical center are both decreasing. The cause is not clear. Better nutrition and the wide-spread use of antibiotics are two possible factors which come to mind, but we know of no scientific evidence that these are responsible. There has been a slight decrease in the mean dietary fiber content in the Swedish diet during the last three decades. The decreased incidence of acute appendicitis cannot therefore be correlated with an increase in the mean dietary fiber intake.
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| 6. |
- Arnbjornsson, E., et al.
(författare)
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Effect of loperamide on faecal control after rectoplasty for high imperforate anus
- 1986
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 152:3, s. 215-216
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Tidskriftsartikel (refereegranskat)abstract
- The effect of loperamide on faecal control after Stephens rectoplasty for high imperforate anus was studied in eight patients more than 8 years after surgery. Clinical assessment and anorectal manometry were performed before and after administration of loperamide for 6 to 8 weeks. Decreased faecal soiling was noted in seven of the eight cases. Obstipation forced two patients to stop the medication. The improved faecal control was verified by an increase in sequeeze pressure at anorectal manometry in four patients. When incontinence persists after Stephens rectoplasty, loperamide can improve the faecal control in some cases.
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| 7. |
- Arnbjornsson, E., et al.
(författare)
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Obstruction of the appendix lumen in relation to pathogenesis of acute appendicitis
- 1983
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 149:8, s. 789-791
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Tidskriftsartikel (refereegranskat)abstract
- The role of obstruction in the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix peroperatively in 33 patients undergoing appendectomy because of suspected acute appendicitis. The technique involved insertion of a fine needle via the apex into the lumen of the appendix and measurement of the hydrostatic pressure required to inject a saline solution. In all six patients with gangrenous appendix and in two patients with phlegmonous appendix there were signs of obstruction of the appendix lumen expressed as raised intraluminal pressure. In 19 patients found at operation to have phlegmonous appendix there were no signs of obstruction. The experimental data suggest that obstruction is not an important factor in the causation of acute appendicitis, but may develop as a result of the inflammatory process.
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| 8. |
- Arnbjornsson, E., et al.
(författare)
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Testicular torsion in children - Bilateral or unilateral operation
- 1985
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 151:5, s. 425-427
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Tidskriftsartikel (refereegranskat)abstract
- Between 1969 and 1984 65 children were operated on for testicular torsion. A follow-up study of 63 patients who underwent surgery for unilateral testicular torsion with fixation only on the affected side showed that no torsion occurred on the opposite nonfixated side and there was no retorsion during an observation period of an average of more than seven years. From our calculated risk for contralateral testicular torsion we suggest that bilateral fixation is not necessary in children who present with a unilateral testicular torsion.
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| 9. |
- Arnbjornsson, E., et al.
(författare)
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The value of physiotherapy for faecal continence after correction of high anal atresia. A clinical and electromyographic study
- 1988
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 154:7-8, s. 467-470
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Tidskriftsartikel (refereegranskat)abstract
- A follow-up study of 12 patients who had undergone Stephens rectoplasty for high imperforate anus is presented. Clinical assessment and anal electromyography were performed more than 7 years after surgery, both before and after a year's physiotherapeutic training of the perianal musculature. Electromyography showed correlation between faecal continence and tonus of the anal sphincter, the anocutaneous reflex and maximal voluntary activity in the perianal muscles. After the physiotherapeutic training there was significant improvement of faecal continence. This effect was electromyographically corroborated. The results confirmed clinical observations that postoperative physiotherapy and training of the voluntary muscles in the perianal region is of value for the achievement of faecal continence.
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| 10. |
- Bergenfelz, A, et al.
(författare)
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Intraoperative fall in plasma levels of intact parathyroid hormone after removal of one enlarged parathyroid gland in hyperparathyroid patients
- 1991
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 157:2, s. 12-109
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Tidskriftsartikel (refereegranskat)abstract
- Plasma levels of intact parathyroid hormone (PTH) were measured intraoperatively before and after removal of one enlarged gland in 20 hyperparathyroid patients. In 13 patients with a single parathyroid adenoma, plasma levels of intact PTH-(1-84) had declined at 15 min after removal of the adenoma by 86.5 +/- 4.4% of baseline in the antecubital vein and by 85.6 +/- 4.2% in the ipsilateral internal jugular vein. In seven patients with parathyroid hyperplasia, the corresponding figures for decline at 15 min after removal of one enlarged parathyroid gland were only 26.6 +/- 6.4% and 7.8 +/- 29.4%. The fall in PTH levels was significantly less in hyperplasia than in adenoma (p less than 0.001). Thus 15 min after removal of one enlarged parathyroid gland, the decline in plasma level of intact PTH may distinguish between single adenoma and multiglandular disease as the cause of hyperparathyroidism.
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| 11. |
- Bergqvist, D, et al.
(författare)
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Abdominal trauma in persons older than 60 years
- 1982
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 148:7, s. 569-573
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Tidskriftsartikel (refereegranskat)abstract
- Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road traffic accidents were the main cause of trauma (48% of cases). The incidence of motor-car accidents rose sharply during the first two decades of the study. Injuries to the liver and bile ducts and multiple intra-abdominal injuries were more common in the elderly than in younger patients, but injury to the abdominal wall was less common. A tendency towards more severe injuries and multiple trauma with extra-abdominal involvement emerged during the study period. The mortality rate was 27.6% in the patients older than 60, but 9.1% in the overall patient series with abdominal trauma. One-third of all the deaths among the older patients were directly due to the abdominal trauma. One consequence of the increasing numbers of old people in the general population is probably that more and more cases of abdominal trauma will be seen in the higher age groups.
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| 12. |
- Bergqvist, D, et al.
(författare)
-
Extraanatomic vascular reconstruction in patients with aorto-iliac arteriosclerosis
- 1984
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 150:3, s. 205-209
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Tidskriftsartikel (refereegranskat)abstract
- During an 11-year period 117 extraanatomic reconstructions were made for aorto-iliac arteriosclerosis; 36 axillofemoral and 81 femorofemoral crossover bypasses. The patients were old and had several factors making them poor risks for surgery. Axillofemoral grafts were more often used in patients with malignant disease. Postoperative mortality was 10% without difference between the two types of reconstruction. Both early and late complications were significantly more frequent in patients with axillofemoral bypass. Reoperations for occlusion and symptoms from the donor side also were significantly more common among axillofemoral patients. Life table analysis showed a higher survival and patency rate among patients with crossover grafts.
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| 13. |
- Bergqvist, D, et al.
(författare)
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Intestinal trauma, Analysis of 101 cases
- 1981
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 147:8, s. 629-635
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Tidskriftsartikel (refereegranskat)abstract
- Intestinal injuries sustained by 101 Swedish patients during the period 1950-1979 are reviewed. The abdominal trauma was blunt in 78 cases and penetrating in 23. Small-bowel and mesenteric, but not large-bowel, injuries showed increasing frequency. This was associated with rising numbers of motorcar accidents. Injuries to other abdominal organs were found in 56 of the 101 patients, particularly in those with mesenteric or large-bowel trauma. Clear physical signs of intra-abdominal injury led to rapid surgical exploration in most cases, but some operations were performed after relatively long observation. Most injuries, including those in the colon, were treated with primary repair or resection. Decompressive colostomy or exteriorization were rarely performed. Deaths were mainly caused by other factors than the type of operation. The mortality rate (35%) was constant.
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| 14. |
- Bergqvist, D, et al.
(författare)
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Trends in civilian vascular trauma during 30 years. A Swedish perspective
- 1987
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 153:7-8, s. 417-422
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Tidskriftsartikel (refereegranskat)abstract
- Vascular injuries operated on during a 30-year period (1955-1984) were analyzed. There has been significant increase of such injuries, particularly the iatrogenic types. The total incidence per 100,000 population and year rose from 11.0 to 26.6. Various angiographic and catheterization techniques were responsible for the iatrogenic increase. The noniatrogenic vascular injuries not infrequently were part of multiple trauma, with fractures and a variety of penetrating wounds. Numerous operative techniques were used, increasingly with reconstructive surgery. The mortality rate did not change in the study period, but the rate of amputations and of various long-term sequelae diminished.
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| 15. |
- Bergqvist, D, et al.
(författare)
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Upper gastrointestinal trauma. Analysis of 45 cases of gastric, duodenal or pancreatic injury
- 1981
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 147:8, s. 637-643
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Tidskriftsartikel (refereegranskat)abstract
- Injuries to the upper gastrointestinal tract occurring over a 30-year period in a geographically well defined region were analyzed. The incidence was low in comparison with other abdominal injuries, but duodenal and pancreatic injuries were increasingly common in the study's last decade. The stomach injuries were mainly caused by penetrating trauma. The duodenal and pancreatic injuries most commonly resulted from road-traffic accidents. Two duodenal injuries were overlooked at the initial exploration, in which the duodenum was incompletely exposed. Anastomotic insufficiency occurred in one of the three patients who underwent duodenal resection. Most of the pancreatic injuries were contusions that could be managed with drainage. The pancreas was severely damaged in five patients, all of whom had multiple intra-abdominal injuries. Three of the five patients died before or during operation.
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| 16. |
- Bowald, S, et al.
(författare)
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Pulmonary microembolism during and after aortic cross-clamping in heparinized and non-heparinized pigs.
- 1980
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 146:5, s. 351-6
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Tidskriftsartikel (refereegranskat)abstract
- The occurrence of pulmonary microembolism after aortic clamping and declamping was investigated in 21 young pigs. The prophylactive effect of heparin was also examined. Eight animals were heparinized, while 13 did not receive heparin. In 15 pigs the plasma concentration of fibrinogen was determined before, during and after clamping of the aorta. External detection of 51Cr-labelled platelets and 125I-labelled fibrinogen was performed. Lung tissue from these animals was homogenized and analysed for radioactivity. Specimens were taken from the lungs of all animals for morphological investigation. A significant decrease in plasma fibrinogen concentration was noted during the aortic clamping in non-heparinized animals. Morphological studies of lung tissue revealed numerous fibrin/platelet thrombi, leukocyte and platelet aggregates, atelectases and bleedings. In homogenized lung tissue, areas with elevated radioactivity were found, indicating fibrin/platelet entrapment. No such changes were seen in pigs pretreated with heparin. It was found that pulmonary microembolism occurs frequently after aortic clamping if heparin is not given at an early stage of the procedure.
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| 17. |
- Claesson, B, et al.
(författare)
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Biliary microflora in acute cholecystitis and the clinical implications
- 1984
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 150:3, s. 229-237
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Tidskriftsartikel (refereegranskat)abstract
- A prospective bacteriologic investigation was made in 43 consecutive patients (mean age 63 years) operated on for acute cholecystitis. Gallbladder bile and wall were cultured, using four methods and with special attention to optimal anaerobic technique. Cultures were positive in 72% of the patients, yielding a wide variety of species (21 species among 48 isolates). Anaerobes constituted 23% of the isolates. Cultures from gallbladder bile and from gallbladder wall gave almost identical results, as did sampling at the beginning and at the end of cholecystectomy. Bactibilia was found in all patients operated on within 48 hours after the onset of symptoms. Bactibilia and postoperative septic complications showed statistically significant correlation with high patient age. Bactibilia and gallbladder gangrene were significantly correlated with preoperative temperature greater than 38.5 degrees C. There was coincidence of strains isolated from local wound sepsis and from peroperatively sampled gallbladder bile. Adequate preoperative or peroperative antibiotic therapy according to susceptibility testing was associated with significantly reduced rate of postoperative septic complications. The study indicates that bacteria are present early in the course of acute cholecystitis and that they are causally important for postoperative morbidity and mortality.
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| 18. |
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| 19. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Intussusception at four separate locations in the small intestine. Case report.
- 1988
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 154:7-8, s. 485-6
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Tidskriftsartikel (refereegranskat)abstract
- A case of intussusception at four different locations in the small intestine is reported. Operative reduction of the interponates were performed with an uneventful postoperative course. The treatment of intussusception in adults is discussed and the literature is reviewed.
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| 20. |
- Hafstrom, L., et al.
(författare)
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Blood flow in experimental liver tumors : Effect of vasoactive drugs
- 1980
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 146:3, s. 149-153
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Tidskriftsartikel (refereegranskat)abstract
- The effects of infused glucagon, histamine and vasopressin on blood flow in anesthetized rats with intrahepatic tumors were studied using microspheres labelled with 99Tcm or 51Cr isotopes. Considerable circulatory effects were noted both in central hemodynamic parameters as well as in organ and tissue blood flows. Glucagon infusion increased blood flow in the spleen and small intestine while hepatic artery flow was unchanged. Histamine induced a decrease in hepatic and pulmonary blood flow. Vasopressin showed a pronounced decrease in blood flow in all organs measured. Relative tumor blood flow was registered as the ratio between tumor flow and arterial hepatic flow. A relative decrease of tumor blood flow in relation to surrounding liver tissue blood flow was registered after infusion of vasopressin. No effects were seen after glucagon or histamine infusion.
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| 21. |
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| 22. |
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| 23. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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The effect of hyperosmolar infusions on survival after hemorrhage
- 1989
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Ingår i: Acta Chirurgica Scandinavica. - : Almqvist & Wiksells. - 0001-5482. ; 155:9, s. 433-438
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Tidskriftsartikel (refereegranskat)abstract
- Hyperglycemia has previously been reported beneficial for survival after hemorrhage. In the present investigation, rats depleted of liver glycogen after 24 h food deprivation were infused either A: isotonic NaCl (300 mosm/kg H2O), B: glucose (1,800 mosm/kg), C: Xylose (2,000 mosm/kg) or D: NaCl (1,800 mosm/kg), during 60 min hemorrhage, and observed for recovery or death for seven days. During hemorrhage, all animals given hyperosmolar infusions had higher serum osmolality and greater plasma refill compared to group A. Increments in serum osmolality correlated inversely to hematocrit developments, p less than 0.05. Only 2/18 animals given isotonic NaCl survived, while survival in the other groups were 14/18 (glucose infused), 20/22 (xylose infused) and 20/20 (hypertonic NaCl). Best survival was noted in the groups with the highest final osmolality, and largest reduction in hematocrits; groups C and D, while significantly more animals given glucose died compared to group D. It is concluded that induction of hyperosmolality during the early phase of hemorrhage is associated with increased survival in hemorrhage, irrespective of hyperosmolar agent infused. The benefits of hyperglycemic hyperosmolality is primarily related to the osmolar properties of this solute, and not the immediate need for glucose as substrate.
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| 24. |
- Mätzsch, Thomas, et al.
(författare)
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Cholescintigraphy: a valuable diagnostic method in acute cholecystitis
- 1983
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 149:2, s. 187-191
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Tidskriftsartikel (refereegranskat)abstract
- In 91 patients (36 men, 55 women) who were hospitalized with symptoms of acute cholecystitis, cholescintigraphy was performed with 99m-Tc-ethyl-IDA, in order to evaluate the method in the diagnosis of acute inflammatory disease of the gallbladder. Five groups of patients were recognized: (A) abnormal scintigraphy and verified gallbladder disease, (B) abnormal scintigraphy without verified gallbladder disease (false positive). (C) normal cholescintigraphy but cholelithiasis (false negative), (D) normal cholescintigraphy and no gallbladder disease, and (E) cholescintigraphy in icteric patients. In the diagnosis of acute cholecystitis the sensitivity was 92% and the specificity was 88%. Cholescintigraphy is a useful method for proving or disproving a diagnosis of acute cholecystitis with non-patent cystic duct. It does not reveal calculi in biliary ducts or in a gallbladder with patent cystic duct. In icteric patients, cholescintigraphy has restricted usefulness at serum bilirubin level around 120 mumol or more.
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| 25. |
- Mätzsch, Thomas, et al.
(författare)
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Influence of standard heparin or low molecular weight heparin on healing of abdominal wounds and colonic anastomoses in rats
- 1987
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 153:10, s. 593-598
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Tidskriftsartikel (refereegranskat)abstract
- The influence of standard heparin or low molecular weight (LMW) heparin on healing of abdominal wounds and colonic anastomoses was studied in rats. Subcutaneous injection of 1 XaI U/g b.w. of standard or LMW-heparin or 0.5 ml physiologic saline was given 12 hours preoperatively and daily for 3 or 7 days postoperatively. Breaking strength of the abdominal wound and the anastomosis was measured, as were haemoglobin and albumin in serum. Hydroxyproline as a measure of collagen and tissue dry weight was determined in standardized segments of colonic wall adjacent to the anastomosis. Except for significant increase in breaking strength of the anastomosis after 7-day injection of LMW heparin, no differences in the parameters of wound healing were found after 3 or 7 days. In rats receiving standard heparin there was increased bleeding tendency (reduced haemoglobin) compared with the LMW-heparin group and the controls. The administered heparin thus did not negatively influence healing, and standard and LMW-heparin did not differ in this respect.
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| 26. |
- Mätzsch, Thomas, et al.
(författare)
-
Low molecular weight heparin compared with dextran as prophylaxis against thrombosis after total hip replacement
- 1990
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 156:6-7, s. 445-450
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Tidskriftsartikel (refereegranskat)abstract
- The effect of low molecular weight (LMW) heparin given once daily as prophylaxis against venous thrombosis was compared with that of dextran 70 in an open randomised trial of 100 patients undergoing elective total hip replacement. Four patients were withdrawn after randomisation and thus 96 were included in the final analysis. The development of thrombus was surveilled by the 125I fibrinogen test, and positive readings were verified by venography. Nine of 47 patients given LMW heparin developed thromboses (19%) compared with 18 of 49 given dextran (37%) (p = 0.09). Two further patients who received LMW heparin developed thromboses after leaving hospital (clinical signs became apparent on days 13 and 17, respectively), giving an overall rate of thrombosis in this group of 23%. Minor wound haematomas occurred in two of 47 in the LMW heparin group and three of 49 in the dextran group (4% and 6%, respectively), and blood loss, transfusion requirements, and reduction in postoperative haemoglobin concentration did not differ between the two groups. The studied LMW heparin given subcutaneously once a day was no less safe or effective than dextran in preventing thromboembolism after total hip replacement.
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| 27. |
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| 28. |
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| 29. |
- Rasmussen, I, 1952-, et al.
(författare)
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Acute solitary diverticulitis of the caecum. Case report.
- 1988
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 154:5-6, s. 399-401
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Tidskriftsartikel (refereegranskat)abstract
- In two cases of suspected appendicitis, laparotomy revealed an inflammatory mass medially in the caecum. Colonic resection was performed in both cases and the final diagnosis was solitary caecal diverticulitis. When inflammation of a caecal diverticulum is recognized at laparotomy, simple diverticulectomy is the procedure of choice, but colonic resection is recommended if malignancy cannot be excluded or inflammatory changes are severe.
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| 30. |
- Rasmussen, Ib, et al.
(författare)
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Jejunoileal bypass for morbid obesity. Report of a series with long-term results.
- 1989
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 155:8, s. 401-7
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Tidskriftsartikel (refereegranskat)abstract
- Of 72 patients who underwent jejunoileal bypass because of morbid obesity, 69 could be evaluated with special reference to long-term (median 11 years) results. One of the other three had fatal anastomotic leakage, one underwent resection and reversal of shunt because of postoperative gangrene in the bypassed segment, and one died of sepsis and liver failure following cholecystectomy 6 months after bypass. The median body mass index (kg/m2) fell from 45.4 preoperatively to 33.2 after 16 years. Shunt-related complications in early and late follow-up were diarrhoea (n = 15), anal/perianal disorders (15), arthralgia (15), urinary calculi (16), cholelithiasis (5), severe flatulence (7), liver cirrhosis (5), intestinal tuberculosis (1), ileitis (1), severe electrolyte disturbance (4), hypomagnesaemia (22), hypokalaemia (8), and deficiency of vitamin B12 (24), iron (24) and folate (17). Although jejunal bypass effectively reduces weight, the patients are at continuous risk of many complications. However, the improvement in quality of life should not be underestimated.
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| 31. |
- Rådberg, Göran, 1945, et al.
(författare)
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Relationship between gallbladder histopathology and ability to concentrate biliary lipids and bilirubin. A study on gallstone patients with functioning gallbladder.
- 1988
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 154:10, s. 581-4
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Tidskriftsartikel (refereegranskat)abstract
- Biliary lipids and bilirubin were measured in hepatic and gallbladder bile obtained at routine cholecystectomy in 35 gallstone patients. The gallbladders had opacified at cholecystography and the cystic ducts were patent at operation. The histologic changes in the gallbladder wall were evaluated by an independent pathologist. Increasing abnormality of the gallbladder wall was shown to be associated with reduced gallbladder contents/hepatic bile ratio of biliary lipids and of bilirubin. The concentrating function of the human gallbladder thus appears to be impaired in proportion to the severity of histologic lesions in its wall. Taken together with earlier findings in vitro, this relationship suggests impaired absorption of electrolytes and water by the gallbladder mucosa, or diffusion of biliary constituents from the lumen of the inflamed gallbladder.
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| 32. |
- Skau, Tommy, et al.
(författare)
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Spontaneous peritonitis and rheumatoid arthritis : a case report
- 1986
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 152:Apr., s. 317-318
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Tidskriftsartikel (refereegranskat)abstract
- An unusual case in which an adult patient with rheumatoid arthritis developed a fulminant spontaneous gram-positive bacterial peritonitis and underwent emergency laparotomy for this condition is presented. Spontaneous peritonitis in adult patients was previously seen only in patients with liver disease, nephrotic syndrome or systemic lupus erythematosus
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| 33. |
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| 34. |
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| 35. |
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| 36. |
- Tegner, Yelverton, et al.
(författare)
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Traumatic disruption of the thoracic aorta
- 1984
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 150:8, s. 635-8
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Tidskriftsartikel (refereegranskat)abstract
- Fourteen cases of injury to the thoracic aorta treated in 1959-1981 are reviewed. Acute rupture was present in nine patients and chronic post-traumatic aneurysm in five. Most of the patients had other, associated injuries, and physical signs of the aortic injury were often scanty. Widening of the mediastinum was the most common roentgenographic finding. All the aortic ruptures were localized to the isthmus. One patient declined surgery. Another died on the operating table just before surgery was started. A third patient died peroperatively from severe bleeding when the aneurysm was dissected free. All of the other 11 patients survived operation without major complications. At follow-up (mean 10 years), ten patients were alive and well and one had died of unrelated cause. The most recent operations were performed with the aid of a TDMAC (Gott) shunt, which makes aortic repair safe and simple. Because aortic trauma often is accompanied by other, severe injuries which make transportation of the patient risky, and so as not to delay operation, the aortic lesions should be repaired at general surgical units. If necessary, a thoracic surgeon should be brought to the hospital
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| 37. |
- Udén, P, et al.
(författare)
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Preoperative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography and scintigraphy
- 1990
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 156:1, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- In 50 patients with primary hyperparathyroidism, investigation before initial neck exploration included ultrasonography, computed tomography and 99technetium-201thallium subtraction scintigraphy. The sensitivity for correct preoperative localization was 50%, 54% and 56%, respectively. There was marked inter-observer variation in assessment of ultrasonography and computed tomography, while scintigrams were evaluated by only one person. The scintigraphic sensitivity increased with size of the glands. In cases where correct preoperative localization permitted unilateral parathyroidectomy, the time for surgery and anesthesia was significantly reduced. A cost-benefit analysis, however, revealed that the financial saving from this time reduction was outweighed by the cost of the localization procedures. The authors conclude that investigations for definition of enlarged parathyroid glands are not indicated prior to unilateral parathyroidectomy.
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| 38. |
- Vagianos, C, et al.
(författare)
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Intraoperative collection of shed blood with citrated compresses for autotransfusion. An experimental study in pigs
- 1990
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 156:2, s. 121-126
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Tidskriftsartikel (refereegranskat)abstract
- Six pigs were used to study whether the collection of shed blood by means of surgical compresses instead of suction traumatizes such blood. In an in vivo part of the study, the whole blood volume of the pigs was retransfused after treatment with citrated compresses, and in an in vitro part the blood was treated extensively with compresses and analyzed. All animals survived, with a minor fall in hemoglobin after 48 hours and a rise in serum citrate concentration at the end of the experiment. A study of the coagulation system revealed no important change after retransfusion of compress-treated blood. In the in vitro part of the study, repeatedly squeezing blood from the compresses increased the concentration of free hemoglobin to a maximum of 5 g/l after ten squeezes, whereas platelets were numerically unchanged. The study indicates that collecting shed blood by means of surgical compresses may be a safe and efficient method.
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| 39. |
- Vagianos, C, et al.
(författare)
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Reversal of lethal citrate intoxication by intravenous infusion of calcium. An experimental study in pigs
- 1990
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Ingår i: Acta Chirurgica Scandinavica. - 0001-5482. ; 156:10, s. 671-675
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Tidskriftsartikel (refereegranskat)abstract
- Intravenous infusions of 750 and 1000 ml 2.2% sodium citrate were given over a 60 min period to 17 pigs to study its effect on aortic pressure, electrocardiogram, ionised calcium, and citrate clearance. In group 1 (seven pigs) the animals did not receive calcium and the median survival time was 30 min (range 20-70 min). In groups 2 and 3 (five in each group) the pigs were treated with calcium chloride infusions (1 ml 10% calcium chloride to 10 ml citrate) and they all survived. In group 1 the ionised calcium concentrations in blood fell to values below 0.4 mmol/l, after which the blood pressure dropped abruptly. In the animals treated with calcium the mean ionised calcium concentration fell to 0.6 mmol/l, whereas total calcium increased to more than 7 mmol/l. The aortic pressure was consistently within normal values in the groups treated with calcium, but in the group that was not treated the blood pressure fell dramatically. There was no correlation between electrocardiographic changes and ionised calcium concentrations. In summary, calcium was an effective antidote to lethal citrate intoxication, and the only reliable method of determining the necessary dose of calcium was monitoring of ionised calcium concentrations.
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| 40. |
- Wadström, J, et al.
(författare)
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Closure of the abdominal wall; how and why? Clinical review.
- 1990
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 156:1, s. 75-82
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Tidskriftsartikel (refereegranskat)abstract
- Closure of the abdomen after surgery has been performed in a multitude of fashions and the literature is flooded with differently tailored studies of this matter. In this paper the available literature in the field has been reviewed with special emphasis on the advantages and disadvantages of continuous or interrupted, mass or layered closure, and on the choice of monofilament or multifilament, resorbable or non-resorbable suture material. After weighing up all the aspects, the authors recommend that the abdomen should be closed with a continuous mass closure technique, using a monofilament suture. No firm conclusion can be drawn from the literature as to whether resorbable or non-resorbable suture should be chosen.
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| 41. |
- Ware, James H., et al.
(författare)
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Osmolar changes in haemorrhage : The effect of an altered nutritional status
- 1982
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Ingår i: Acta Chirurgica Scandinavica. - : Almqvist & Wiksells. - 0001-5482. ; 148:8, s. 641-646
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Tidskriftsartikel (refereegranskat)abstract
- Fed and 24-30 hour starved rats were submitted to haemorrhagic hypotension, 70 mmHg, with a modified Wigger's system. Neuroleptanalgesia was used to ensure a normal degree of stress reactivity. Despite fed animals losing 53% of their original blood volume (BV) and starved animals 47% (BV=6% prestarved body weight), blood gas data and creatinine levels confirmed a well intact and compensated status in both groups. Fed animals compensated for the greater haemorrhage with a haematocrit reduction which was double that in starved animals. When the alterations in osmole skeletons were compared, evidence for an intracellular fluid (ICF) shift to the interstitium was obtained infed rats. Their NaCl space increased by 5.5%. Glucose increased its osmolar effect by 224% among fed animals and was reduced in those which had been starved. Glucose was identified as the solute causing an acute mobilisation of ICF to the interstitium.
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