[Medical history taking--only for the physician?].
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Humans↗
Biomedical subjects
A Viste
Publications and source records attributed to A Viste.
Effects of prolonged increased intra-abdominal pressure on gastrointestinal blood flow in pigs.
BACKGROUND: The aim of the study was to investigate the effects of prolonged intra-abdominal pressure on systemic hemodynamics and gastrointestinal blood circulation. METHODS: The intra-abdominal pressure in anesthetized pigs was elevated to 20 mmHg (7 animals), 30 mmHg (7 animals), and 40 mmHg (4 animals), respectively. These pressures were maintained for 3 h by intra-abdominal infusion of Ringer's solution. A control group of seven animals had normal intra-abdominal pressure (IAP). Transit time flowmetry and colored microspheres were used to measure blood flow. RESULTS: An IAP of 20 mmHg did not cause significant changes in systemic hemodynamics or tissue blood flow. An IAP of 30 mmHg caused reduced blood flow in the portal vein, gastric mucosa, small bowel mucosa, pancreas, spleen, and liver. Serum lactate increased in animals with an IAP of 30 mmHg, but microscopy did not disclose mucosal damage in the stomach or small bowel. An IAP of 40 mmHg was followed by severe circulatory changes. CONCLUSIONS: Prolonged IAP at 20 mmHg did not cause changes in general hemodynamics or gastrointestinal blood flow. Prolonged IAP at 30 mmHg caused reduced portal venous blood flow and reduced tissue flow in various abdominal organs, but no mucosal injury. A prolonged IAP of 40 mmHg represented a dangerous trauma to the animals.
Animals↗
Dysphagia caused by an embryonic triple epithelial duplication cyst.
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Adult↗
Endoscopic sphincterotomy in acute gallstone pancreatitis: a prospective study of the late outcome.
OBJECTIVE: To describe the outcome after acute biliary pancreatitis in patients treated during the acute attack by endoscopic sphincterotomy without cholecystectomy. DESIGN: Prospective observational study. SETTING: University hospital, Norway. SUBJECTS: 130 patients with gallstones and acute pancreatitis. In 62 patients with common bile duct stones the bile duct was cleared by sphincterotomy and stone extraction. The remaining 68 patients had prophylactic sphincterotomy. Cholecystectomy was not planned later. MAIN OUTCOME MEASURES: Incidence of recurrent acute pancreatitis and need for cholecystectomy. RESULTS: 21 patients were dead or not available for the follow-up. Consequently 109 patients were followed-up for a median of 39 months (range 23-62). One patient had recurrent pancreatitis. 20 patients had a cholecystectomy later for symptoms related to gallstone disease. Of the rest, 25 patients had moderate or mild gallstone-related symptoms. There was no difference in gallstone-related symptoms between those who had had stones in the bile duct and those who had not. 63 patients had no symptoms related to gallstones. CONCLUSION: Endoscopic sphincterotomy during or immediately after acute gallstone pancreatitis resulted in half the patients being free of symptoms during the next three years.
Acute Disease↗
Comparison of a linear miniature ultrasound probe and a radial-scanning echoendoscope in TN staging of esophageal cancer.
BACKGROUND: Endoscopic ultrasonography is a precise method for TN staging of esophageal cancer. We explored the staging properties of a linear miniprobe as compared with a radial-scanning echoendoscope. METHODS: Sixty-eight patients with esophageal cancer underwent preoperative TN staging using a 20-MHz linear miniprobe and a 7.5/12-MHz radial-scanning echoendoscope. Tumor stage was verified by surgery and/or histology. RESULTS: T and N stages were verified in 53 and 54 patients, respectively. T-staging accuracy using the echoendoscope was 70%. The high-frequency miniprobe could not differentiate between T3 and T4 tumors, but both systems had an accuracy of 87% in discriminating between T1, T2, and T3/4 stages. With traversable tumors, the accuracy of N staging was significantly better with the echoendoscope than with the miniprobe (90% vs. 48%, P = 0.008). CONCLUSIONS: The two endosonographic systems had similar accuracy for assessing transmural tumor growth, but the echoendoscope was superior in staging advanced transmural tumors and in predicting lymph node metastasis with traversable tumors.
Aged↗
Upper gastrointestinal contrast study in the management of small bowel obstruction--a prospective randomised study.
OBJECTIVE: To find out whether contrast radiography helps to resolve small bowel obstruction. DESIGN: Prospective randomised trial. SETTING: University hospital, Norway. SUBJECTS: 98 consecutive patients with symptoms of small bowel obstruction and a plain abdominal radiograph that confirmed the diagnosis. INTERVENTIONS: The patients were randomly allocated to receive a mixture of barium and sodium diatrizoate (Gastrografin) (n = 48) or not (n = 50). Both groups were followed up clinically and by repeated abdominal films. MAIN OUTCOME MEASURES: Non-operative resolution of small bowel obstruction; number of patients with strangulated bowel; bowel resections; mortality; complications; hospital stay; and time from admission to operation. RESULTS: No significant differences were observed between the groups in the incidence of non-operative resolution (31/48 in contrast group, 35/50 in control group, OR: 0.89), strangulation obstruction (1/48 in contrast group, 4/50 in control group, OR: 0.24), bowel resection (3/48 in contrast group, 4/50 in control group, OR: 0.76), complications (8/48 in contrast group, 5/50 in control group, OR: 1.80), mortality (3/48 in contrast group, 1/50 in control group, OR: 3.26), and hospital stay (0-7 days: 34/48 in contrast group, 38/50 in control group, p = 0.95). The contrast group had a shorter interval between admission and operation than the control group (0-24 hours: 12/48 in contrast group, 3/50 in control group, p = 0.005). CONCLUSION: The contrast examination did not contribute to the resolution of small bowel obstruction.
Adult↗
Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience.
OBJECTIVE: To study factors influencing complications and death after operations for small bowel obstruction (SBO) using multifactorial statistical methods. SUMMARY BACKGROUND DATA: Death after surgery for SBO is believed to be influenced by factors such as old age, comorbidities, bowel gangrene, and delay in treatment. No studies have been reported in which adverse factors related to death and complications have been systematically investigated with modern statistical methods. METHODS: The authors studied retrospectively 877 patients who underwent 1,007 operations for SBO from 1961 to 1995. Patients with paralytic ileus, intussusception, and abdominal cancer were excluded. Odds ratios for death, complications, postoperative hospital stay, and strangulation were calculated by means of logistic regression analyses. RESULTS: Death and complication rates decreased during the study period. Old age, comorbidity, nonviable strangulation, and a treatment delay of more than 24 hours were significantly associated with an increased death rate. The rate of nonviable strangulation increased markedly with patient age. Major factors increasing the complication rate were old age, comorbidity, a treatment delay of more than 24 hours, and the need for repeat surgery. CONCLUSION: Death and complication rates after SBO decreased from 1961 to 1995. Major factors influencing the rates were age, comorbidity, nonviable strangulation, and treatment delay. Nonviable strangulation was more common in old patients.
Age Factors↗
Effect of cimetidine on development of gastric cancer in rats after gastrojejunostomy.
OBJECTIVE: To find out if cimetidine has an immunomodulating effect on gastric carcinogenesis in rats. DESIGN: Experimental prospective study. SETTING: Teaching hospital, Norway. ANIMALS: 132 male PGV/Mol rats given gastrojejunostomies. INTERVENTION: Half the rats were given cimetidine in their drinking water postoperatively for a minimum of 38 weeks. They were killed after 52 weeks observation and the stomach was investigated macroscopically and microscopically. MAIN OUTCOME MEASURE: In the cimetidine fed group 19/48 animals developed cancer (49%), versus 12/43 (28%) in the control group (p = 0.24). CONCLUSION: Cimetidine had no immunomodulatory effect on the development of gastric cancer in rats.
Adjuvants, Immunologic↗
Closure of burst abdomen after major gastrointestinal operations--comparison of different surgical techniques and later development of incisional hernia.
OBJECTIVE: To find out the incidence of incisional hernia in patients who had resuture of a burst abdomen and to compare different methods of wound closure and the development of incisional hernia. DESIGN: Retrospective study. SETTING: University hospital, Norway. SUBJECTS: 78 adults patients who had their burst abdomens resutured between January 1986 and December 1995. INTERVENTIONS: Five different methods were used to close the burst abdomen: interrupted or continuous sutures with or without retention sutures, or retention sutures alone. MAIN OUTCOME MEASURE: Incisional hernia after at least one year follow-up. RESULTS: Postoperative mortality was 14% (11/78), and 53 patients were followed up for at least a year. Incisional hernias developed in 43% (23/53) of the patients. When interrupted sutures were used (with or without retention sutures) 34% (13/38) of patients developed incisional hernias compared with 6/10 when the wound was closed with a continuous suture. Retention sutures did not reduce the incidence of incisional hernia. CONCLUSIONS: Incisional hernia is a common complication after resuture of a burst abdomen. We found no significant differences in the incidence of incisional hernias when continuous and interrupted techniques were compared. Retention sutures do not reduce the incidence of incisional hernias. There is still a need for refinements of the technique of closure of a burst abdomen.
Adult↗
Wound complications after major gastrointestinal operations. The surgeon as a risk factor.
BACKGROUND: Wound complications occur quite often after abdominal operations. Numerous studies have been performed in the last decades focusing on closure methods, incisions and suture materials. However, the most important factor, the individual surgeon, has hardly been taken into account in these studies. METHODS: This study presents results from a prospective randomised study on abdominal wall closure focusing on the results of the individual surgeon. RESULTS/CONCLUSIONS: We found no differences in the complication rate between different suture materials or between continuous and interrupted closure techniques. There are marked individual differences in complication rates between surgeons. Regular audit with feedback to individual surgeons is an important instrument for quality improvement.
Adolescent↗
Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts. Long-term results.
PURPOSE: To evaluate the long-term results of single-session alcohol sclerotherapy of symptomatic benign liver cysts. MATERIAL AND METHODS: 23 cysts in 19 patients were treated by single-session percutaneous catheterization and injection of 96% ethanol. Evaluation of long-term results was possible in 11 cysts (volume 200-2,700 ml, mean 1,317 ml) in 11 patients. Time of observation was 12-67 months, mean 38.3 months. RESULTS: The reduction of volume was 93-100% (mean 98%). The re-accumulation of fluid after therapy seen in 9 patients proved to be transitory. Except for pain there were no complications. CONCLUSION: Single-session sclerotherapy resulted in satisfactory cyst volume reduction in all 11 long-term follow-up patients.
Adult↗
Pain management of pancreatic cancer.
Quality of life is receiving increasing attention as a criterion for the assessment of treatment, not least for surgery, in pancreatic cancer. In exocrine pancreatic cancer there are three main symptoms that must be dealt with: pain, loss of weight and jaundice. All of them seriously impair quality of life, but most often pain is the most feared by the patients. Despite this, the intensity and the quality of the pain is all too often only scantly described. In 85 consecutive patients with newly diagnosed pancreatic cancer we have prospectively registered the quality and quantity of their pain and correlated it to tumor and patient characteristics. It was found that about one fourth of the patients were totally pain free and half of all suffered a pain described by two or less on a Visual Analogue Scale. Only one in ten had severe pain. Although more and more patients were treated with morphine, it was still about one third of all patients that had no or only little pain in the last part of their life. Pain had a strong correlation to survival. This may be due to secondary effects like depressing the mood of the patient and reducing the food intake, but is probably more often a reflection of that generalized cancer induces more pain. Analgesic drugs are the cornerstone of the pharmacologic management of pain due to pancreatic cancer. A significant part of the patients do well with only paracetamol and nonsteroidal antiinflammatory agents. Combining these agents with narcotic analgesics can enhance pain control while lessening the dose of narcotics. A wide range of narcotics are available as well as different modes for delivery: regular pills, slow release forms, injections, subcutaneous injections, epidural etc. Each patient's pain management should be individualized, based on the intensity of pain, the type of pain and the side effects. It is essential not only to describe the medication, but also to follow-up the development of the pain and the patient's total experience of the situation. As an alternative to narcotics, plexus celiac blocks have been used with somewhat different result; in the hands of the experts the percutaneous approach is usually sufficient, but in the hands of other also poor results are reported. During the last years thoracoscopic splanchnicectomy has been tried as a complement giving long-standing pain relief with little or no side effects in the majority of patients. With this approach the sympathetic fibers lead by the symphathetic chain and further by the nervus splanchnicus major, minor and minors are divided. The denervation is easily done and can be performed bilateraly in one seance. This method will probably be used more often as the technique is now well described.
Humans↗
Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty.
OBJECTIVE: To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. SUMMARY BACKGROUND DATA: GB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. METHODS: Forty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. RESULTS: The prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. CONCLUSIONS: The prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB.
Adult↗
Herniation of the stomach and necrotizing chest wall infection following laparoscopic Nissen fundoplication.
UNLABELLED: This paper addresses gastric herniation following laparoscopic fundoplication for reflux esophagitis. CASE HISTORY: A 46-year-old woman underwent Nissen fundoplication. Two days postoperatively she developed gastric herniation and perforation with subsequent pleural effusion and necrotizing fasciitis of the chest wall. A patent crural repair might reduce the occurrence of paraoesophageal herniation.
Acute Disease↗
Single-session alcohol sclerotherapy in benign symptomatic hepatic cysts.
PURPOSE: To evaluate the results of single-session alcohol sclerotherapy in benign symptomatic liver cysts. MATERIAL AND METHODS: Ten cysts (volume 200-4,800 ml) in 10 patients were treated by percutaneous catheterization and injection of 96% ethanol at a dose of 10% of the cyst volume but never more than 100 ml. The treatment was applied for a maximum of 20 min, after which the alcohol and catheter were removed. RESULTS: A satisfactory reduction in cyst volume was achieved in all patients. In 8 patients there was a re-accumulation of fluid during the first period after therapy, followed by a significant reduction in volume on later follow-up examinations. Except for pain, there were no complications. CONCLUSION: Sclerotherapy as a single-session procedure resulted in a significant reduction in cyst volume in all 10 patients. The postprocedural re-accumulation of fluid seen in 8 patients proved to be temporary. It was not necessary to repeat the sclerotherapy procedure in any patient.
Adult↗
Reactive pleuropericarditis following laparoscopic fundoplication.
Postpericardiotomy syndrome is not uncommon following cardiac surgery. The syndrome is characterized by fever, chest pain, leucocytosis, and signs of pericardial and pleural effusions. A patient with similar symptoms after laparoscopic treatment of reflux esophagitis is reported. Antibiotic treatment had no effect on a suspected bacteriological infection. There was a dramatic clinical response to corticosteroid treatment. The etiology and pathogenesis of the syndrome are discussed.
Adult↗
A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections.
515 patients with intra-abdominal infection participated in an open randomized comparative multicenter trial in order to compare the efficacy, safety, and tolerance of imipenem/cilastatin with cefuroxime/metronidazole. 258 patients (mean age 56 years) received imipenem/cilastatin 1.5-2.0 g/day, and 257 patients (mean age 54 years) received cefuroxime 3.0-4.5 g/day plus metronidazole 1.0-1.5 g/day for at least 3 days. 130/161 evaluable patients (80.8%) receiving imipenem/cilastatin and 124/145 evaluable patients (85.5%) receiving cefuroxime/metronidazole were clinically cured. The microbiological response was favorable in 86.9% in the imipenem/cilastatin group and in 90.8% in the cefuroxime/metronidazole group. The two treatment groups were similar with respect to median time to defervescence which was 4 days. The median duration of treatment was 6 days and the median time to discharge from hospital was 9 days in both groups. Drug-related adverse reactions were observed in 14 patients receiving iminpenem/cilastatin and in 8 patients receiving cefuroxime/metronidazole. 19 patients in the imipenen/cilastatin group and 12 patients in the cefuroxime/metronidazole group died. No correlation was found between the deaths and the study drugs. The present study shows that intra-abdominal infections can be treated successfully with imipenem/cilastatin as well as with cefuroxime/metronidazole.
Abdomen↗