| 1. |
- Appelros, Stefan, et al.
(author)
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Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden
- 1999
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 86:4, s. 465-470
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Journal article (peer-reviewed)abstract
- BACKGROUND: There is a wide range (5-50 per 100 000) in the reported annual incidence of acute pancreatitis. Furthermore, the predominant aetiology varies in different reports. This study was undertaken to establish the current incidence, aetiology and associated mortality rate in a defined population. METHODS: A retrospective study of all cases of acute pancreatitis admitted over a 10-year period to a single institution was performed. In addition the autopsy and forensic materials were reviewed. RESULTS: Altogether 883 attacks of acute pancreatitis were recorded, of which 547 were first attacks. The annual incidence of first attacks was 23.4 per 100 000. Including relapses, the incidence was 38.2 per 100 000. Biliary disease was the main aetiological factor in first attacks whereas alcohol was the predominant factor when relapses were included. The mean annual mortality rate for acute pancreatitis in the population was 1.3 per 100 000. Of 31 patients who died from acute pancreatitis only 15 were diagnosed before death. For recurrent disease the mortality rate was 0.3 per cent. In 12 patients the pancreatitis was associated with pancreatic carcinoma. CONCLUSION: It is important to differentiate between first attacks and relapses, since both incidence and aetiology figures are influenced by this, and it is important to include autopsy and forensic material in population-based mortality studies.
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| 2. |
- Franzén, Thomas, 1955-, et al.
(author)
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Prospective study of symptoms and gastro-oesophageal reflux 10 years after posterior partial fundoplication
- 1999
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 86:7, s. 956-960
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Journal article (peer-reviewed)abstract
- Background:This was a prospective study of symptoms, and short-term and long-term reflux competence after partial fundoplication.Methods:Some 101 patients were operated consecutively with posterior partial (270°) fundoplication. Indications for surgery were reflux disease without erosive oesophagitis in 25 patients, moderate oesophagitis in 43, severe oesophagitis in 25 and paraoesophageal hernia in eight. Symptom score, manometry and pH tests were performed before operation, 6 months after operation and after 6–14 years.Results:All patients (n = 101) were free from heartburn and regurgitation at early follow-up. There was evidence of clinical recurrence at late follow-up (n = 87) in two of 22 patients without oesophagitis before operation, two of 39 with moderate oesophagitis before operation and three of 19 patients with severe oesophagitis before operation; 92 per cent had good reflux control at late follow-up.ConclusionPosterior partial fundoplication shows excellent reflux control at early follow-up. Ten years later fewer than 10 per cent of patients have recurrence, which is more common in patients who had severe oesophagitis before operation.
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| 3. |
- Nilsson, E., et al.
(author)
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Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996
- 1998
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 85:12, s. 1686-1691
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Journal article (peer-reviewed)abstract
- BackgroundDifficulties in obtaining and analysing outcome measures in hernia surgery may be an obstacle to necessary progress in non-specialized hospitals. Against this background a voluntary register was initiated in 1992 with the aim of describing and evaluating hernia surgery in participating units.MethodsProspective registration of all hernia operations carried out in participating hospitals was undertaken using identification codes specific for each individual. Repair technique, complications, day surgery, type of anaesthesia, and reoperation for recurrence were recorded. Actuarial analysis was used to determine the cumulative incidence of reoperation. Relative risk for reoperation was estimated by the Cox proportional hazards model.ResultsThe number of participating hospitals and registered operations increased from eight and 1689 respectively in 1992 to 21 and 4056 in 1996. The use of mesh increased from 7 per cent of all operations in 1992 to 51 per cent in 1996. The proportion of operations done for recurrent hernia remained constant at 16–17 per cent throughout the 5-year study period. For all 12 542 herniorrhaphies registered, the cumulative incidence of reoperation at 2 years was 3 (95 per cent confidence interval 3–4) per cent. Postoperative complications, recurrent hernia, direct hernia and absorbable suture were associated with increased risk of reoperation for recurrence. An increased incidence of reoperation, although not statistically significant, was noted for conventional open repairs (Bassini, McVay, Marcy and others) versus the Shouldice technique.ConclusionIn this prospective audit an increasing use of mesh was observed for open and laparoscopic surgery, especially for bilateral and recurrent hernia operations. Reoperation rates decreased significantly between 1992 and 1995.
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| 4. |
- Bergqvist, D, et al.
(author)
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Comparison of the cost of preventing postoperative deep vein thrombosis with either unfractionated or low molecular weight heparin
- 1996
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In: British Journal of Surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 83:11, s. 1548-1552
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Journal article (peer-reviewed)abstract
- The relative costs were analysed of (1) no prophylaxis against deep vein thrombosis (DVT), (2) selective treatment of DVT after confirmation of diagnosis, (3) general prophylaxis with standard low-dose unfractionated heparin and (4) general prophylaxis with low molecular weight heparin (LMWH) in patients undergoing elective general abdominal surgery or elective hip surgery. The mean calculated costs per patient undergoing general abdominal surgery were: Swedish crowns (SEK) 1950 for no prophylaxis, SEK 5710 for selective treatment of DVT, SEK 735 for prophylaxis with unfractionated heparin and SEK 665 for prophylaxis with LMWH. The corresponding costs for hip surgery were SEK 3930, SEK 10790, SEK 1730 and SEK 1390 respectively. Thus, the least expensive management strategy in patients undergoing elective general abdominal or hip surgery would appear to be general prophylaxis with either unfractionated heparin or LMWH. Furthermore, general prophylaxis with LMWH would appear to be more cost-effective than general prophylaxis with unfractionated heparin.
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| 5. |
- BERGQVIST, D, et al.
(author)
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Low molecular weight heparin started before surgery as prophylaxis against deep vein thrombosis: 2500 versus 5000 XaI units in 2070 patients
- 1995
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In: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 82:4, s. 496-501
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Journal article (peer-reviewed)abstract
- The optimal administration regimens of low molecular weight heparins (LMWHs) have not yet been established. The aim of this study was to compare the efficacy and safety of 2500 and 5000 Xal units of the LMWH dalteparin in patients undergoing elective general surgery for malignant and benign abdominal disease. Prophylaxis was started in the evening before surgery and given once-daily every evening thereafter. The study was designed as a prospective, randomized, double-blind, multicentre trial. Some 66.4 per cent of patients were operated on for a malignant disorder. The primary endpoint was deep vein thrombosis (DVT) detected with the fibrinogen uptake test. Bleeding complications were recorded and classified. Analysis was made both on an intention to treat basis and in patients given correct prophylaxis (86.3 per cent). A total of 2097 patients were randomized and 27 excluded after randomization. A technically correct fibrinogen uptake test was obtained in 1957 patients. The incidence of DVT was significantly lower in patients given 5000 Xal units, this being true for both correct prophylaxis (6.8 versus 13.1 per cent, P < 0.001), on an intention to treat basis (6.6 versus 12.7 per cent, P < 0.001), and in patients with malignant disease (8.5 versus 14.9 per cent, P < 0.001). Sixty-seven patients (3.2 per cent) died within 30 days with no difference between the groups. There were two cases of fatal pulmonary embolism. The frequency of bleeding complications in the whole series was higher in patients randomized to 5000 Xal units (4.7 versus 2.7 per cent, P = 0.02), although this was not the case in those operated on for malignant disease (4.6 versus 3.6 per cent, P not significant). Dalteparin in the dose of 5000 Xal units started in the evening before surgery has a good thromboprophylactic effect in high-risk general surgery at the cost of a small bleeding risk. In patients with malignant disease there was no increased risk of bleeding. The overall frequency of fatal pulmonary embolism with dalteparin is extremely low, even in this high-risk group of patients.
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| 6. |
- ERIKSSON, S, et al.
(author)
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Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis
- 1995
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In: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 82:2, s. 166-169
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Journal article (peer-reviewed)abstract
- In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment hi patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.
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| 7. |
- Glimelius, B, et al.
(author)
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Surgical management of rectal cancer
- 1996
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In: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 83, s. 869-
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Journal article (other academic/artistic)
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| 8. |
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| 9. |
- HOLM, T, et al.
(author)
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Abdominoperineal resection and anterior resection in the treatment of rectal cancer: results in relation to adjuvant preoperative radiotherapy
- 1995
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In: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 82:9, s. 1213-1216
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Journal article (peer-reviewed)abstract
- The outcome of patients with rectal cancer treated by abdominoperineal or anterior resection, with or without preoperative radiotherapy, was assessed to detect any differences attributable to the operative method and interactions between radiotherapy and type of surgery. The study was based on 1292 patients included in two consecutive controlled randomized trials of preoperative radiotherapy in operable rectal carcinoma. The outcome was not related to surgical method. Radiotherapy increased postoperative mortality and complications and reduced local and distant recurrence, but had no effect on overall survival. Effects of radiotherapy were similar irrespective of the type of surgery, except that the increase in postoperative mortality in irradiated patients was greater in those treated with abdominoperineal resection. Sphincter-saving procedures appear to have no adverse effects on outcome of rectal cancer, but the optimum use of radiotherapy is still to be defined.
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| 10. |
- Holm, T, et al.
(author)
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Postoperative mortality in rectal cancer treated with or without preoperative radiotherapy: causes and risk factors
- 1996
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In: The British journal of surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 83:7, s. 964-968
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Journal article (peer-reviewed)abstract
- Adjuvant preoperative radiotherapy in patients with rectal cancer improves local control and possibly overall survival. However, an increased postoperative mortality rate after radiotherapy has been observed in some trials. This study was based on 1399 patients in two randomized trials of radiotherapy. It reviewed the causes of death after operation and attempted to identify risk factors for postoperative mortality in patients with rectal cancer treated with or without high-dose (5 × 5 Gy) preoperative radiotherapy. The majority of deaths were from cardio vascular disease or infection. The risk of postoperative mortality was significantly increased in patients irradiated with a two-portal technique to a relatively large volume compared with those not given radiotherapy, but not in those irradiated with a four-portal technique to a limited volume. Age, sex, tumour stage and coexistent cardiovascular disease were independent risk factors for postoperative mortality. The risk of postoperative death in patients with rectal cancer is related to the preoperative radiotherapy technique.
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