| 1. |
- Aarum, S, et al.
(författare)
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Operation for primary hyperparathyroidism: the new versus the old order. A randomised controlled trial of preoperative localisation
- 2007
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 96:1, s. 26-30
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Tidskriftsartikel (refereegranskat)abstract
- In patients with primary hyperparathyroidism (PHPT), parathyroid imaging is nowadays routinely used for the purpose to perform a focused unilateral minimally invasive operation. The outcome of this new strategy has, however, not been established in randomised trials. Material and Methods: Patients were randomised to either preoperative localisation with sestamibi scintigraphy and ultrasonography (group I) or no preoperative localisation (group II). In group I, a minimally invasive parathyroidectomy was performed in patients in whom both localisation studies were consistent with a single pathological gland, whereas a conventional bilateral neck exploration was performed in cases with negative localisation findings. In group II all patients underwent conventional bilateral neck exploration. Primary outcome measure was normocalcaemia at 6 months postoperatively. Results: In the preoperative localisation group (group I) 23/50 (46%) of the patients could be operated on with the focused operation whereas 26/50 (52%) were operated on by bilateral neck exploration. All patients in the no localisation group (group II; n=50) were operated on with the intended bilateral neck operation. Normocalcaemia was obtained in 96% and 94% in group I and II, respectively. Total (localisation and operative) costs were 21% higher in group I. Conclusions: Routine preoperative localisation, with the intention to perform minimally invasive parathyroidectomy, is not cost effective if concordant results of scintigraphy and ultrasonography are a prerequisite for the focused operation. Less than half of the patients were successfully managed with this strategy, at a higher cost and without obtaining a more favourable clinical outcome.
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| 2. |
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| 3. |
- Bergqvist, David
(författare)
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Introduction of new technology : the surgical point of view
- 2009
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 98:1, s. 3-7
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Forskningsöversikt (refereegranskat)abstract
- Introduction of new non-pharmacological technology is challenging and the methodology for evaluating such technologies is much less standardized than when dealing with new pharmacological substances. It is, however, as important to use randomized design with blinded assessment and combine that with prospective population based registries to be able to analyze generalizability.
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| 4. |
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| 5. |
- Björck, Martin
(författare)
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Invited commentary
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 153-153
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Björck, Martin, et al.
(författare)
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The clinical importance of monitoring intra-abdominal pressure after ruptured abdominal aortic aneurysm repair
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 183-190
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Forskningsöversikt (refereegranskat)abstract
- AIM: The aim of this paper was to review the literature on the clinical importance of monitoring intra-abdominal pressure (IAP) after ruptured abdominal aortic aneurysm (rAAA) repair. METHOD: The literature was searched for abdominal compartment syndrome (ACS) or intra-abdominal pressure and aortic aneurysm. Original articles were studied. Personal experiences were reported. RESULTS: The Consensus Documents of the World Society on the Abdominal Compartment Syndrome (wsacs.org), with their definitions and guidelines, constitute an important step forward for the possibilities to study this clinical entity. Few papers were published describing the problem specifically in the patient population operated on for ruptured abdominal aortic aneurysm (rAAA). The incidence was approximately 5% when the patients were not monitored with IAP, and above 10% when IAP was monitored. The incidence seems to be similar irrespective if open or endovascular repair is performed, though comparative prospective studies were not published. Patients with intra-abdominal hypertension (IAH) or ACS have higher mortality and more complications. If IAH is recognized early conservative treatment may be effective to prevent development of ACS. After ACS has developed, surgical decompression is usually required. A proposed algorithm on how to act on different levels of IAH is presented. CONCLUSIONS: IAH/ACS is an important complication after operation on patients with rAAA. Monitoring IAP may be associated with improved outcomes.
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| 7. |
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| 8. |
- Jersenius, U, et al.
(författare)
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Liver operations in Sweden in 1987-99
- 2005
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 94:1, s. 25-30
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Tidskriftsartikel (refereegranskat)abstract
- Liver surgery is developing with new techniques and treatment modalities. The aim of this study is to describe liver surgery over a long period of time in a country with a public health care system. Patients and Method: A register study including adult patients admitted for liver resection in Sweden (population 8.8 million) selected from the Inpatient Register 1987–99. Additional data were collected from the Swedish Cancer Register and the Cause of Death Register. Analyses of the patients, indications, mortality and causes of death are presented. Results: 2,405 operations were performed (21 per million per year). The most frequent indication was colorectal metastases (27 %). The 5-year survival after an operation for primary liver cancer and colorectal liver metastases was 27 % and 26 %, respectively. Conclusions: Few patients were admitted for liver operations compared to expected figures. The survival rates are in conformity with those previously published. With an increasing awareness of the relatively favourable prognosis and the introduction of new methods, the volume of liver operations will probably increase in Sweden.
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| 9. |
- Larsson, Sune
(författare)
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Cement augmentation in fracture treatment
- 2006
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 95:2, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- Surgical treatment of fractures close to joints, especially in osteoporotic patients, is often associated with problems to obtain. adequate strength of the bone-implant construct as well as sufficient purchase for screws in the weak bone. One way to address this increasing problem is through the development of new metal implants specifically designed for fixation of fractures in osteopenic bone. An alternative strategy is to develop methods for augmentation of the weak bone that surrounds the metal implant. In most instances augmentation is achieved by using injectable cement to reinforce the bone. Conventional PMMA provides good strength but due to several drawbacks it has never gained general acceptance for fracture augmentation. More recently several injectable cements based on calcium-phosphate, calcium-sulphate or bioglass has been developed for augmentation of fractures in the extremities as well as for vertebral compressive fractures in the spine. On the basis of biomechanical studies and the clinical experience so far, cement augmentation will enable faster rehabilitation, as the strength of the cement makes it possible to allow full weight-bearing earlier than conventional metal implants alone. More clinical studies are needed in order to refine the surgical technique, develop cement types aimed for fracture treatment and define the most appropriate indications and limitations of augmentation for fracture repair. The purpose of this article is to review the possible use of augmentation as a technique in the treatment of fractures in the extremities as well as in the spine.
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| 10. |
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| 11. |
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| 12. |
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| 13. |
- Ljungman, Christer, et al.
(författare)
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Propositions for refinement of the hybrid surgical technique for treatment of thoraco-abdominal aortic aneurysm
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 174-177
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Forskningsöversikt (refereegranskat)abstract
- Traditional open repair of thoraco-abdominal aortic aneurysms Crawford type II-IV carries a high perioperative risk and mortality. The hybrid technique for combined surgical and endovascular treatment offers an interesting alternative with reduced risk of paraparesis and possibly a reduced mortality rate. Propositions for refinement of this approach are outlined based on a single centre experience.
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| 14. |
- Madanat, R., et al.
(författare)
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RSA applications in monitoring of fracture healing in clinical trials
- 2006
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 95:2, s. 119-127
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Tidskriftsartikel (refereegranskat)abstract
- Radio stereometric analysis (RSA) was originally developed as a method for performing highly accurate three-dimensional measurements in vivo over time from sequential radiographs. Since its introduction over twenty years ago, the RSA method has proven itself as a powerful tool with numerous orthopaedic applications. RSA has been used extensively in studies of prosthetic fixation and has been shown to be the method of choice for these studies. RSA has, however, also been successfully applied to a limited number of studies examining fracture healing, namely in fractures of the radius, ankle, tibial plateau, trochanter and femoral neck, as well as studies of bone healing following spinal fusion and tibial osteotomies. RSA follow-up of a fracture will provide definitive demonstration of the exact time of union, i.e. the achievement of fracture stability. This information can be invaluable in randomized clinical trials of fracture treatment. Phantom model studies have proven useful for effective preoperative planning and interpretation of RSA results. The RSA method is a highly accurate, precise and safe objective method for studying fracture healing in clinical trials. The RSA method may serve as a scientific tool to accurately evaluate the significance of supporting novel biomaterials for the early stability and the rate of healing in fractures.
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| 15. |
- Norgren, Lars, et al.
(författare)
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Endovascular repair of the ruptured abdominal aortic aneurysm
- 2008
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Ingår i: Scandinavian Journal of Surgery. - Helsinki : The Finnish Surgical Society. - 1457-4969 .- 1799-7267. ; 97:2, s. 178-181; discussion 181-2
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Forskningsöversikt (refereegranskat)abstract
- The present knowledge on endovascular repair of ruptured abdominal aortic aneurysms (rAAA) prevents firm conclusions when to use this method in comparison to open repair. This review article briefly summarizes results from case series, and discusses how to achieve reliable information despite the absence of randomized controlled trials. At present a careful conclusion might be that dedicated centers with an adequate organization and reasonably high volume of abdominal aortic aneurysm (AAA) should use detailed registry protocols to achieve experience and data to create an as reliable basis as possible for future recommendations.
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| 16. |
- Nyman, Rickard, 1952-, et al.
(författare)
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The future of imaging in the management of abdominal aortic aneurysm
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 110-115
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Forskningsöversikt (refereegranskat)abstract
- The development of endovascular techniques depends on the concomitant development of imaging techniques. Imaging with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MR) is evolving at rapid pace. Angiography has largely been replaced by these techniques as a diagnostic tool in the clinical setting. New methods, e.g., rotational angiography and intravascular ultrasound, will play an important role in endovascular treatment of vascular disease. It is necessary to have easy access to ultrasonography, CT and MR images in future hybrid angiographic/surgical suites and the operator must be able to do advanced immediate reconstructions in a sterile environment. The combined use of advanced imaging, open and endovascular techniques will further improve the treatment of vascular disease in the future.
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| 17. |
- Olofsson, Pia, et al.
(författare)
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Multipel Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock
- 2009
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 98:1, s. 41-47
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haernorrhagic shock compared with conventional surgery. Methods: Eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. The animals were bled to a mean arterial pressure of 50 mm Hg for 30 minutes, after which they were resuscitated and had laparotomy. They were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel injuries and early rapid multiple bowel ligation group (n=9). Repeated measurement analysis of variance was used for analysis. Results: There was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. Lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. There were no significant differences in mean arterial pressure, cardiac output, stroke volume or systemic vascular resistance between the groups. The mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (SEM) minutes, compared with 116.4 (1.74) (SEM) minutes in the conventional surgery group, p = <0.001). Conclusions: Damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.
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| 18. |
- Schumacher, MC, et al.
(författare)
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Robotic cystectomy
- 2009
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 98:2, s. 89-95
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Tidskriftsartikel (refereegranskat)
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| 19. |
- Ström, Håkan, et al.
(författare)
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Unrestricted weight bearing and intensive physiotherapy after uncemented total hip arthroplasty
- 2006
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 95:1, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: The effectiveness of partial weightbearing after hip surgery has been questioned as well as the need of intensive physiotherapy. Material and Methods: 36 patients (average age 54.4,19 women) operated with uncemented hip arthroplasty were randomized either to unrestricted weightbearing (UWB) combined with intensive physiotherapy or to partial weightbearing (PWB) for 3 months combined with a short self-training program. The load during walking and the muscle strength (MS) in abduction was measured preoperative and subsequent up to 12 months. Results: The average peak load on the operated leg at one week was 39.0 kg for the UWB and 25.8 for the PWB group (P = 0.009) while at three months 70.0 and 31.7 (P = 0.001) respectively. At 6 and 12 months there were no differences between the groups. The muscle strength increased in both groups up to six months but there were no differences between the groups. Conclusions: Even though patients applied more load than the recommended 15 kg most patients were able to comply with partial weightbearing fairly well. The effect of intensive physiotherapy on the muscle strength after hip arthroplasty is questionable.
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| 20. |
- Swedenborg, J
(författare)
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Abdominal aortic aneurysm in the interval 5.0-5.5 cm, art or evidence?
- 2008
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 97:2, s. 128-130
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Tidskriftsartikel (refereegranskat)abstract
- The risk of rupture for aneurysms 5–5.5 cm in diameter has not been specifically studied. Two large randomised trials, the United Kingdom Small Aneurysm Trial and the Aneurysm Detection And Management study Trial concluded that immediate surgical repair did not offer any benefit compared to surveillance and surgical repair if the aneurysm reached 5.5 cm or became symptomatic. Despite these findings many indications today suggest that a lower threshold should be used in patients with higher risk for rupture e.g. women or low risk of mortality in connection with AAA repair such as patients in the lower range of ages.
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| 21. |
- Swedenborg, J
(författare)
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The most wanted trials for abdominal aortic aneurysm treatment
- 2008
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 97:2, s. 161-164
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Tidskriftsartikel (refereegranskat)abstract
- This overview contains suggestions for two different types of trials, medical treatment of small aneurysms and methods for selection of aneurysms in need of intervention. Questions in need of answers are evaluation of the influence on growth and rupture by medical treatment and parameters other than absolute diameter for selection of patients for open surgical or endovascular intervention. These questions need not necessarily be answered by randomised controlled trials.
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| 22. |
- Troeng, Thomas
(författare)
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Volume versus outcome when treating abdominal aortic aneurysm electively : is there evidence to centralise?
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 154-159
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Forskningsöversikt (refereegranskat)abstract
- AIM: To identify evidence for the minimum annual case load of open repairs of abdominal aortic aneurysms compatible with an acceptable perioperative mortality rate. METHOD: A PubMed search resulted in 137 references, sixteen articles with original data on volume and mortality not older than ten years were identified and selected for review. RESULT: Three studies found no volume-mortality relationship when controlled for age, sex and medical risk. Six studies verified volume thresholds of 20 procedures per year or more. In seven studies hospital volumes of 7-17 elective abdominal aortic aneurysm (AAA) repairs per year were sufficient to reach a mortality rate of a national average or similar to that of higher volume centres. No studies were published on the minimum annual case-load of EndoVascular Aneurysm Repair (EVAR), or of a combination of EVAR and open repair. CONCLUSION: Recent studies in North America and in Europe indicate that 10-15 procedures annually can be sufficient to safely perform open AAA repairs. Centres regularly performing less should consider referral. Continuous monitoring and audit of risk-adjusted perioperative mortality rates should be practiced in all centres.
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| 23. |
- Volpe, C, et al.
(författare)
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The role of adrenal scintigraphy in the preoperative management of primary aldosteronism
- 2008
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Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 97:3, s. 248-253
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Tidskriftsartikel (refereegranskat)abstract
- Differentiation between the two major subgroups of primary aldosteronism, bilateral hyperplasia and aldosterone producing adenoma is essential since therapy in the former is medical and in the latter surgical. The aim of the present study was to evaluate the clinical utility of adrenocortical scintigraphy in the management of primary aldosteronism. Material and Methods: [131I] norcholesterol (NP-59) scintigraphy with dexamethasone suppression for subclassification and lateralization of primary aldosteronism was evaluated in 49 patients with long-term follow-up after diagnosis and treatment Results: Thirty-three patients with the diagnosis of aldosterone producing adenoma were operated with adrenalectomy. Preoperative scintigraphy showed lateralized isotope uptake in 27/33 patients while 6 showed no uptake. Twenty-two were cured and three significantly improved. Thus, in 25/33 (76%), scintigraphy showed the correct side as the patients benefited of surgery. Two patients did not improve. Fourteen patients with a probable diagnosis of bilateral hyperplasia had normal scintigraphies. Conclusions: In the present retrospective study we found limited sensitivity of NP-59 scintigraphy. However, when a lateralized scintigraphic uptake is achieved it has a high accuracy. Scintigraphy may be used as an adjunct in cases where adrenal venous sampling is inconclusive.
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| 24. |
- Wanhainen, Anders
(författare)
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How to define an abdominal aortic aneurysm : influence on epidemiology and clinical practice
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 105-109
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Forskningsöversikt (refereegranskat)abstract
- Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta. There is, however, no general agreement on how to define an AAA. The lack of a uniform definition may have consequences on epidemiology and clinical practice. Several proposed definitions of an AAA exist, all based on the diameter of the abdominal aorta. Age, gender, and body size are all associated with the aortic diameter, and may therefore also be of importance when evaluating the aortic diameter. The precision of the measurement and the awareness of imaging shortcomings are also important. In order to demonstrate a true widening of the aorta the relation to adjacent aortic segments must be assessed. To demonstrate an expansion of a potential aneurysm, a follow-up period with repeated assessments is required. Thus, a fixed diameter does not serve as a proper definition of an aneurysm, but rather as a cut-off level for further assessment and/or follow-up.
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| 25. |
- Wanhainen, Anders, et al.
(författare)
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Screening for abdominal aortic aneurysm : areas where information is still inadequate
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 131-135
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Forskningsöversikt (refereegranskat)abstract
- Abdominal aortic aneurysm (AAA) fulfils the criteria for a disease suitable for screening. However, important aspects need to be further analysed; the optimal age of the male population considered for screening has not yet been established, and whether women or specific high risk groups would benefit from screening has not been sufficiently evaluated. The impact of the current shift toward a high proportion of AAA repair done with endovascular technique and the long-term effect on QoL are additional issues that have not been adequately studied. Furthermore, therapeutic options for small AAA as well as secondary prevention programmes have to be developed.
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| 26. |
- Wanhainen, Anders, et al.
(författare)
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The value of a nationwide vascular registry in understanding contemporary time trends of abdominal aortic aneurysm repair
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1457-4969 .- 1799-7267. ; 97:2, s. 142-145
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Forskningsöversikt (refereegranskat)abstract
- Nationwide vascular registries offer rapid feed-back in an environment of fast new technical development, as is the case with the treatment of abdominal aortic aneurysm (AAA). Furthermore, they offer an opportunity to study non-selected, population-based data. The aim of this review was to analyze time-trends in published papers from nationwide registries on AAA-repair. In contrast to several US reports, an increased rate of intact AAA repair, associated with the introduction of endovascular repair, was reported in a recent publication based on the Swedish Vascular Registry (Swedvasc). The rate of ruptured abdominal aortic aneurysm (rAAA) repair is stable in most reports, while some report a decreasing incidence. Most nationwide studies report a reducing mortality over time after intact AAA repair, while time trends on the mortality after ruptured AAA repair are more heterogenic.
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| 27. |
- Dahlin, Lars
(författare)
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Techniques of peripheral nerve repair.
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:4, s. 310-316
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Tidskriftsartikel (refereegranskat)abstract
- Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.
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| 28. |
- Gudbjartsson, T, et al.
(författare)
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Congenital diaphragmatic hernia: Improved surgical results should influence abortion decision making
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:1, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare surgical results for congenital diaphragmatic hernia (CDH) in two Scandinavian university hospitals and to evaluate the effects of abortions on the clinical profile of CDH in Iceland. Methods: A retrospective study including all CDH-cases in Iceland 1983-2002 and children referred to Lund University Hospital 1993-2002. Aborted fetuses with CDH from a nation-wide Icelandic abort-registry were also included. Results: In Iceland, 19 out of 23 children with CDH were diagnosed < 24 hours from delivery, one with associated anomalies. Eight fetuses were diagnosed prenatally and seven of them aborted, three having isolated CDH at autopsy. In Iceland, 15 of 18 children operated on survived surgery (83% operative survival). In Lund 28 children were treated with surgery, 23 of them diagnosed early after birth or prenatally. Four children did not survive surgery (86% operative survival) and 9 (31%) had associated anomalies. All the discharged children treated in Iceland and Lund are alive, 3-22 years postoperatively. Conclusion: CDH is a serious anomaly where morbidity and mortality is directly related to other associated anomalies and pulmonary hypoplasia. However, majority of CDH patients do not have other associated anomalies. In spite of improved surgical results (operative mortality < 20%), a large proportion of pregnancies complicated with CDH are terminated. We conclude that the improved survival rate after corrective surgery must be emphasized when giving information to parents regarding abortion of fetuses with a prenatally diagnosed CDH.
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| 29. |
- Lindblad, Bengt, et al.
(författare)
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What to do when evidence is lacking--implications on treatment of aortic ulcers, pseudoaneurysms and aorto-enteric fistulae.
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:2, s. 165-173
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Tidskriftsartikel (refereegranskat)abstract
- Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available. MATERIAL: From our centre we collected 65 patients treated with open (n = 15) or endovascular reconstruction (n= 50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment. RESULTS: Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended. CONCLUSION: Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.
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| 30. |
- Malina, Martin, et al.
(författare)
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EVAR and complex anatomy: an update on fenestrated and branched stent grafts.
- 2008
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:2, s. 195-204
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Tidskriftsartikel (refereegranskat)abstract
- Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair (OR). EVAR is preferred by patients due to the reduction of surgical trauma. Approximately 20% of patients have aneurysm neck morphology which is inadequate for a standard stent graft and requires the endograft to cross vital aortic side branches to achieve a seal. This chapter describes the evolution of three types of devices, namely the fenestrated and branched stent grafts as well as the chimney grafts. These stent grafts incorporate vital aortic side branches in the repair, thereby increasing the applicability of EVAR which may improve the overall results.
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| 31. |
- Moberg, Ann-Cathrin, et al.
(författare)
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An open access technique to create pneumoperitoneum in laparoscopic surgery.
- 2007
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Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 96:4, s. 297-300
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An open access technique might reduce severe vascular and visceral injuries. An open access technique through the umbilical cicatrix tube has been developed as a routine method with the goal to be easy, safe and used by all surgeons in patients without a previous midline incision. AIM: To evaluate the open technique in a prospective study in 100 consecutive laparoscopic operations regarding time for entrance, surgeons experience and BMI of the patients. METHODS: A midline incision from the linea alba up into the inverted umbilicus was performed in the cicatrix tube and the peritoneum was penetrated allowing air to flow into the abdominal cavity followed by a blunt trocar insertion. RESULTS: Time for access was median 93 seconds. Entrance time in patients with BMI >30 (n=18) was 100 sec and with BMI <30 it was 90 sec (p = 0.71). The median time for consultants was 88 sec and for residents 120 sec (p = 0.003). No gas leakage was seen. Prolonged time for access was seen in three patients; two equipment failures and one obese patent. CONCLUSION: The open access technique is applicable in all patients without a former midline incision. It is fast, easy to learn with very few associated problems.
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| 32. |
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| 33. |
- Örtenwall, Per, 1951
(författare)
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Disaster preparedness in Scandinavia
- 2005
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Ingår i: Scandinavian journal of surgery. - 1457-4969. ; 94:4, s. 319-20
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Tidskriftsartikel (refereegranskat)abstract
- Disaster preparedness in Scandinavia is being improved on the national level, with increased cooperation between the different countries following 9/11. However, focus so far has been largely directed against CBRN threats. The reduction of hospital beds along with centralisation of advanced care as well as financial strains will enforce a closer cooperation between the health boards. The federal health care authorities must have a clear-cut responsibility and mandate to coordinate the nations health care systems in peacetime disasters, and not only during war. This reorganisation has just merely begun.
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