Acta chirurgica Scandinavica (Acta Chir Scand)

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Other titles The European journal of surgery, Acta chirurgica, Eur J Surg
ISSN 0001-5482
OCLC 23657406
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: In 545 consecutive patients undergoing elective or emergency surgery for colorectal cancer (370 colon and 175 rectum), mortality and morbidity were analysed in different age groups with special reference to patients over 80 years old. In that group, 33% had an emergency operation, compared with 18% below that age. Postoperative mortality after elective surgery ranged from 3 to 11% in the different age groups, but was not significantly related to age. In contrast, postoperative in-hospital mortality after emergency surgery was high (38%) among those older than 80 years, compared with 6% below 75 years and 24% between 76 and 80 years. Postoperative morbidity, i.e. infections and cardiovascular disease, increased with age, as did the length of hospital stay. Five-year survival, independent of age, was poorer after emergency surgery than after elective surgery. It is concluded that elective colorectal resection for cancer in elderly patients is a safe procedure.
    Acta chirurgica Scandinavica 09/2000; 154(11-12):659-63. DOI:10.1016/S0140-6736(00)02707-0
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    ABSTRACT: Seventeen men with peripheral arterial insufficiency and intermittent claudication (maximum walking tolerance less than 1000 m) underwent a bypass operation (group A, n = 8) or carried out simple exercises (repeated heel-raising) at home (group B, n = 9). The effects of treatment on the isokinetic performance of the plantar flexors and on fatiguability were assessed. Before treatment both groups had similarly low Doppler pressure indices, maximum performance and fatiguability level. Maximum walking tolerance was increased by treatment in both groups. Maximum plantar flexor output rose in group A, partly due to increased range of motion, but was only slightly changed in group B. Bypass surgery also led to increased electrical efficacy (contractional work/integrated electromyogram). Plantar flexor fatiguability normalized in six of the eight group A men, but in only a few from group B. Improvement in group B may be explained by specific adaptation of (mainly type 2B) muscle fibres. After bypass the increased capacity to remove combustion products may be the major reason for normalized fatiguability. Bypass surgery is preferable for most cases of intermittent claudication.
    Acta chirurgica Scandinavica 01/1998; 154(5-6):363-9.
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    ABSTRACT: Two methods for treatment of chronic pilonidal disease were compared in a randomised trial of 100 patients with a mean follow-up of 29 months. Four patients were excluded from the excision and closure group, leaving 96 patients for analysis. Initial primary healing was significantly more frequent after excision and primary closure (45/46; 98%) compared with excision and healing by secondary granulation (36/50; 72%). The mean healing time was significantly shorter in the excision and closure group (10.3 days) compared to the excision and granulation group (13 weeks). There was, however, no significant difference between the two groups in cure rate after the first operation. The recurrence rate in the excision and granulation group was 12% and after primary closure 20%. The presence of stiff hair and anaerobic bacteria were related to the failure of primary healing, but not associated with recurrence. Although the cure rate was the same regardless which operation was done, the primary healing was quicker and the healing time and duration of sick-leave were shorter after primary closure. Excision with primary closure therefore seems to be the preferable method.
    Acta chirurgica Scandinavica 11/1990; 156(10):695-9.
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    ABSTRACT: Direct repair of anal sphincter injuries was undertaken in seven patients, three men and four women. Obstetrical tears were the cause of injury in all the female patients; surgical trauma, road traffic accident, and sexual assault caused the injuries to the men. Temporary covering colostomies were fashioned for six patients either before, or at the time of, the repair. There were no major complications associated either with the repairs or with the colostomy closures. The degree of incontinence was reduced in all patients, but only two became completely continent after the operation. The change in anal sphincter pressures was not significant. Postanal repair was subsequently undertaken for one woman, but all the other patients were satisfied with their repairs. We conclude that direct sphincter repair should be the treatment of choice for patients with major injury to the anal sphinchter.
    Acta chirurgica Scandinavica 11/1990; 156(10):723-7.
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    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.
    Acta chirurgica Scandinavica 11/1990; 156(10):677-81.
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    ABSTRACT: A 34-year-old man and a 71-year-old woman underwent radical removal of mediastinally sited chondrosarcoma, presumably originating in the periosteum of the vertebral body. The man (with mesenchymal chondrosarcoma) died of remote metastasis 6 years postoperatively. The woman (poorly differentiated chondrosarcoma, grade 2-3) is still alive 2 years after the operation.
    Acta chirurgica Scandinavica 11/1990; 156(10):733-6.
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    ABSTRACT: A 28-year-old woman, gravida 1, para 0, presented with toxemia, abruptio placenta and disseminated intravascular coagulopathy. Rupture of the liver with hypotension and oliguria occurred 36 hours after a stillbirth. The patient died of multiple organ failure 9 days after delivery.
    Acta chirurgica Scandinavica 11/1990; 156(10):741-2.
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    ABSTRACT: A series of 138 major liver resections undertaken between 1971 and 1987 were reviewed. Intrabdominal abscesses developed in 11 (8%) patients, a mean of 23 days (range 10-42) after operation and two died (mortality 18%). Eight developed after 63 right hepatectomies, two after 24 right lobectomies, one after 34 left hepatectomies and none after left lobectomies (17). Patients who developed intra-abdominal abscesses underwent significantly longer operations (mean (SEM) 400 (48) compared with 275 (21) min) (p less than 0.05) and had significantly more bleeding during the operation (7,600 (1,750) compared with 3,200 (430), p less than 0.01) than those who did not. The amounts recovered from the abdominal drains, both before and after the diagnosis, were comparatively greater in patients with abdominal abscesses. Antibiotic prophylaxis was given to 10 of 11 patients who did and 89 of 127 patients who did not, form abscesses. We conclude that the risk of intra-abdominal abscess formation after major liver resection is increased: when a large amount of liver tissue is removed (right hepatectomy or lobectomy); when there is a lot of intraoperative bleeding; and when the operation takes a long time. Antibiotic prophylaxis did not affect the risk of abscess formation this series.
    Acta chirurgica Scandinavica 11/1990; 156(10):707-10.
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    ABSTRACT: A total of 107 male Wistar rats had abdominal hernias repaired (3 weeks after they had been artificially induced) by a two layer closure of the abdominal wall--the Mayo technique. The wounds of 56 rats were subjected to constant stimulation by an electric flow field. An implanted stimulation unit provided a low frequency (0.87 Hz), bipolar, symmetrical rectangular pulsed current (+/- 25 microA). A control group were given units that did not transmit current. In 39 of the 51 animals in the control group the muscle margins of the abdominal scars separated by between 1 and 5 mm. The scars of the electrostimulated animals were distinguished histologically by early formation of fibroblasts and deposition of collagen and the rapid maturation and longitudinal alignment of the collagen fibres. 46 of 56 of these scars were not separated. This technique may have a clinical application as adjuvant treatment for relapses of incisional hernias.
    Acta chirurgica Scandinavica 11/1990; 156(10):701-5.
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    ABSTRACT: The effect of dietary zinc deficiency on the breaking strength of abdominal skin incisions was studied in rats 21 days postoperatively. Zinc deficiency was induced with a low-zinc diet (1.4 mg zinc/kg diet) 14 days preoperatively. Thereafter serum zinc was reduced by 60%, but the zinc concentration in unwounded skin and liver remained similar to that of pair-fed controls given a zinc-adequate diet (33 mg zinc/kg). The wound breaking strength (maximal load until wound disruption) was significantly lower in the zinc-deficient group (75% that of control wounds). The zinc concentration in wound tissue had decreased in the zinc-deficient group, but the wound hydroxyproline concentration was similar in the two groups. The results indicate that zinc is an important trace element during the early remodeling of scar tissue.
    Acta chirurgica Scandinavica 11/1990; 156(10):667-70.
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    ABSTRACT: A 37-year-old woman presented with hoarseness two days after developing pain while undergoing physiotherapy for tension in her neck. Computed tomography showed a probably benign mass near to the left lobe of the thyroid, which was found at operation to be attached to the recurrent laryngeal nerve. The nerve was dissected free, the tumour removed, and the patient and her voice recovered fully. Histological examination confirmed a benign cyst in extraglandular thyroid tissue and the patient is well two years later.
    Acta chirurgica Scandinavica 11/1990; 156(10):737-9.
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    ABSTRACT: Malignant schwannoma of the small intestine is rare and diagnosis often late. Histologic distinction from fibrosarcoma and leiomyosarcoma may require electron microscopy. The primary treatment is surgical. Close postoperative observation is recommended because of the tendency to recurrence. Remission after chemotherapy has been reported, but without controlled studies. The 5-year survival rate is unknown. Two cases are presented.
    Acta chirurgica Scandinavica 11/1990; 156(10):729-32.
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    ABSTRACT: Forty-one patients admitted with first episode of bleeding from esophageal varices were enrolled in a trial of the efficacy of oral propranolol to prevent rebleeding during the course of endoscopic sclerotherapy until obliteration. Single-blind randomization to sclerotherapy alone or with propranolol was used. At monthly endoscopy the varices were injected with 1% Aethoxysclerol until obliteration. If bleeding recurred, additional sclerotherapy was given. There was no intergroup difference in time to eradication of varices (8.1 vs. 7.7 months). The cumulative number of bleedings from varices and from distal esophageal ulcerations was identical in the two study groups. Five patients in the control group but only one in the propranolol group died of bleeding in the study period, a difference of only borderline significance (chi 2 = 4.08, df = 1). There were no specific side effects of propranolol. Thus propranolol did not significantly reduce the frequency of rebleeding until variceal obliteration, but could have had some influence on the gravity of rebleeding.
    Acta chirurgica Scandinavica 11/1990; 156(10):711-5.
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    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.
    Acta chirurgica Scandinavica 11/1990; 156(10):671-5.
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    ABSTRACT: Using a new experimental model of protein-calorie starvation, the impact of malnutrition on liver regeneration, and the changes in liver composition during malnutrition and regeneration, were studied. Forty-one rats were allocated to one of 3 groups: group I (n = 13) were normally nourished rats which underwent partial hepatectomy, group II (n = 16) were semistarved rats which underwent partial hepatectomy, and group III (n = 12) were normally nourished rats which underwent sham operations. Liver biopsy specimens were taken at the time of partial hepatectomy and when the rats were killed after 48 hours of regeneration. The samples were used for determination of water, fat, glycogen, protein, DNA, and RNA content. The replication rate of liver cells was measured by autoradiography after continuous incorporation of tritium labelled thymidine. Malnutrition was associated with a higher postoperative mortality and a reduced rate of regeneration. The livers changed during malnutrition with a reduction in both size and glycogen concentration. After 48 hours of regeneration there was a marked change in liver composition with severe fatty degeneration, a fall in glycogen and a rise in water content. RNA concentration was stimulated during regeneration, but during malnutrition the protein content decreased. The results emphasise the importance of an adequate nutritional state for liver regeneration.
    Acta chirurgica Scandinavica 11/1990; 156(10):717-22.
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    ABSTRACT: Thyroid tissue was collected from 60 patients during operations for various thyroid conditions. The tissue's angiogenic capacity was assessed in a chick chorioallantoic membrane preparation. Angiogenic activity was observed in 22 (85%) of 26 solitary follicular neoplasms, in none of ten papillary carcinomas and in one of seven glands with Graves' disease (all pretreated with propranolol). Of 17 glands with euthyroid multinodular colloid goitre, three (18%) showed angiogenic activity. No angiogenic activity was detected in normal thyroid tissue from 26 patients. Angiogenic activity of diseased human thyroid does not seem to be a marker of thyroid malignancy.
    Acta chirurgica Scandinavica 11/1990; 156(10):683-7.
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    ABSTRACT: Venous calf pump function was evaluated with special reference to distribution and severity of deep venous reflux at different levels. A combination of ultrasonography, foot volumetry and venous plethysmography was used in 100 consecutive patients, 32 of whom were also studied with phlebography and intravenous pressure measurements. A clear relationship was found between clinical stage of chronic venous insufficiency and number of segments with reflux. Clinically important deep venous insufficiency was found particularly in patients with reflux in the distal posterior tibial veins, even in the presence of competent popliteal valves. The results demonstrated the calf pump to be functionally divided into a series of pumps, with the distal part more important than the proximal. The importance of evaluating venous valvular function at different levels for adequate assessment of venous calf pump function is emphasized.
    Acta chirurgica Scandinavica 11/1990; 156(10):689-94.
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    ABSTRACT: Duodenocaval fistula is exceedingly rare. Penetrating trauma, gunshot wounds and toothpick perforation of the duodenum are known aetiological factors. Two recent case reports have implicated radiation-induced ulceration of the duodenum. We describe the first case of duodenocaval fistula resulting from a giant peptic ulcer of the descending duodenum.
    Acta chirurgica Scandinavica 10/1990; 156(9):647-50.
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    ABSTRACT: Ten patients had their large bowel continuity restored (5 after Hartmann resection and 5 after defunctioning left colostomy) by an improved, essentially aseptic, stapling technique with the premium CEEA stapler. There were no deaths and no complications.
    Acta chirurgica Scandinavica 10/1990; 156(9):633-5.
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    ABSTRACT: To evaluate the various operations for caecal volvulus we reviewed 48 patients who were treated between 1948 and 1989. Six were treated conservatively (the volvulus resolved before operation), and the remaining 42 patients (43 operations) were treated by untwisting (n = 14, 2 early deaths); caecopexy (n = 13, no deaths); caecostomy (n = 3, 2 early deaths); or resection (n = 13, one early death). At follow up a mean of 11.8 years later (range 0.4 to 34) the numbers of patients who had remained free of symptoms were 6, 5, 1 and 9, respectively. We conclude that resection gives the best long term results with acceptable mortality and morbidity and should be the treatment of choice for caecal volvulus.
    Acta chirurgica Scandinavica 10/1990; 156(9):629-31.