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Biomedical subjects

A Viste

Publications and source records attributed to A Viste.

At least 37 records · Page 2Linked to original sources
PubMed1999

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↗
PubMed1999

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↗
PubMed1999

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↗
PubMed1998

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↗
PubMed1997

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↗
PubMed1997

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↗
PubMed1997

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↗
PubMed1996

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↗
PubMed1995

Morbidity, ability to swallow, and survival, after oesophagectomy for cancer of the oesophagus and cardia.

OBJECTIVE: To study survival, morbidity, and ability to swallow, after oesophagectomy for cancer of the oesophagus and cardia. DESIGN: Prospective open study. SETTING: University hospital, Norway. SUBJECTS: 83 patients, 38 with squamous cell carcinoma and 45 with adenocarcinoma of the oesophagus and cardia. INTERVENTIONS: Transhiatal (n = 51) and transthoracic (n = 32) oesophagectomy. Oesophageal replacement was by either stomach (n = 80) or colon (n = 3). Cervical anastomosis was used in all but 2. MAIN OUTCOME MEASURES: Early and late morbidity and mortality, length of stay in intensive care unit and in hospital, and survival analysis. RESULTS: 30 Day and in hospital mortality were 0 and 4% for transhiatal, and 6% and 9% for transthoracic, oesophagectomy. Complications included recurrent nerve palsy (n = 7), anastomotic leaks (n = 5), and chylothorax (n = 4). 17 Patients (22%) needed dilatations for stenosis of the anastomosis, and 71 (85%) of the patients left hospital within four weeks of operation. Survival analysis showed a 5 year survival rate of 33% for patients with adenocarcinoma operated on for cure and a 2 year survival of 28% for patients with squamous cell carcinoma. CONCLUSIONS: Oesophagectomy for cure is worthwhile as some patients are cured and most of the remainder have prolonged relief of their dysphagia. Palliative resections should not be done in patients with distant metastases or invasion of adjacent organs by the tumour because of long stay in hospital, appreciable morbidity, and short life expectancy.

Adenocarcinoma↗
PubMed1994

[Diagnosis and treatment with endoscopic retrograde cholangiopancreatography].

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out for the first time in 1968. Five years later endoscopic sphincterotomy was performed. Since then both modalities have become established as necessary adjuncts in the diagnosis and treatment of patients with pathology in the bile duct or pancreas. The main indication is common bile duct stone, and as a consequence of this treatment fewer patients are now treated surgically. Patients with malignant bile duct obstruction can be given reasonable palliation of both jaundice and pruritus and therefore improved quality of life. Some reports indicate that endoscopic drainage may be useful for pancreatic stenosis. Complications are few, but vigilance and prompt treatment is necessary to keep morbidity at a minimum. Follow-up after several years shows that sphincterotomy is successful also in the long term. The authors discuss the present diagnostic and therapeutic situation.

Bile Duct Diseases↗
PubMed1994

Prognostic importance of radical lymphadenectomy in curative resections for gastric cancer.

OBJECTIVE: To evaluate the effect of extensive lymphadenectomy on survival in patients with gastric cancer. DESIGN: Retrospective analysis SETTING: University Hospital, Norway. SUBJECTS: 183 patients with stomach cancer resected for cure during the time period 1980-90. INTERVENTIONS: 78 patients had an R1- and 105 patients and R2 resection. 124 patients were treated by total gastrectomy, 5 by proximal--and 54 by distal resection. MAIN OUTCOME MEASURES: Morbidity, mortality and long term survival. RESULTS: The morbidity was 33% (60/183), of which 39 (21%) were general complications (pneumonia, thrombosis, or cardiovascular disease). 14 patients died postoperatively (8%). By logistic regression analysis we found that splenectomy was the only variable associated with both morbidity and immediate postoperative mortality. Five year survival was 39% for patients who had undergone curative resections, 30% for patients who had had an R1 resection, and 47% for those who had had an R2 resection. By multivariate analysis (Cox) we found that N-classification (TNM), tumour diameter of less than 45 mm, type of lymph node dissection (R2) and operation period (after 1984) correlated with improved survival. CONCLUSION: Extensive lymph node dissection improves survival without increasing morbidity or postoperative mortality.

Adult↗
PubMed1994

Complications during the introduction of laparoscopic cholecystectomy in Norway. A prospective multicentre study in seven hospitals.

OBJECTIVE: To assess the morbidity of laparoscopic cholecystectomy since its introduction in Norway in the Autumn of 1990. DESIGN: Postal collection of prospectively collected data. SETTING: Practices of 26 surgeons in 7 district and university hospitals. SUBJECTS: 527 patients who underwent laparoscopic cholecystectomy. INTERVENTIONS: 133 patients (25.5%) had endoscopic retrograde cholangiopancreatography before operation, and two had cholangiograms during operation; dissection was by electrocautery in 490 patients and by laser in 37. MAIN OUTCOME MEASURES: Morbidity, number converted to open operation, and number who required reoperation. RESULTS: There were no deaths and a total of 70 complications (13.3%), 8 of which were after laser dissection. There were 59 local complications (11.2%) and 11 general (2.1%); 12 patients (2.3%) required reoperation for bleeding (n = 5), biliary leak (n = 4), and incisional hernia (n = 3). One had a retained stone in the common duct. 42 were converted to open operation (8.0%), 11 because of complications (bleeding, n = 6; damage to the bile duct, n = 3; and bowel perforation, n = 2). Of the 28 patients with acute cholecystitis 5 (17.9%) had to be converted to open operations and 7 (25.0%) developed complications. 2 of these patients had bile duct injury. CONCLUSION: The morbidity during the introductory period of laparoscopic cholecystectomy in Norway is higher than that reported elsewhere, indicating that the risk of complications is increased during the learning period.

Bile Ducts↗
PubMed1993

[Spontaneous esophageal rupture. Differential diagnosis from acute myocardial infarction].

Chest pain is a common cause of hospitalization. Occasionally, chest pain is due to spontaneous perforation of the oesophagus, a dangerous condition that is often misdiagnosed. This case illustrates different aspects of Boerhaave's syndrome. In patients with chest pain of uncertain etiology, chest radiographs or CT scan of the thorax should be performed. If pneumo-(hydro) thorax and/or mediastinal air is observed, oesophageal contrast studies must be carried out to verify perforation of the oesophagus. The preferred treatment is immediate operation and closure of the defect.

Aged↗
PubMed1993

Norwegian multicentre study of survival and prognostic factors in patients undergoing curative resection for gastric carcinoma. The Norwegian Stomach Cancer Trial.

The influence of clinical and tumour-related variables on long-term survival in patients with gastric carcinoma was studied in a national prospective multicentre study. A total of 532 patients underwent curative surgery with a 5-year survival rate of 40 per cent. In a Cox multivariate analysis, age, stage of disease and macroscopic appearance of tumour were the only factors that independently affected survival. The estimated probability of survival to 5 years for a 50-year-old patient with a flattened tumour type and stage I disease was 71 per cent, but 50 per cent for an 80-year-old with the same tumour type and stage. For stage II disease the rates were 56 and 32 per cent, for stage III 39 and 13 per cent and for stage IV 19 and 3 per cent, respectively. A 70-year-old patient with stage II linitis plastica tumour type had an estimated probability of 5-year survival of 20 per cent. Stage of disease was the single most important factor in determining survival. Laurén histopathological type and location of tumour, Karnofsky performance index, weight loss and type of resection had no significant effect on long-term survival.

Age Factors↗
PubMed1992

Is Lauren's histopathological classification of importance in patients with stomach cancer? A national experience. Norwegian Stomach Cancer Trial.

This study was performed to investigate the association between Lauren's histopathological classification system and different clinico-pathological characteristics in patients with gastric carcinoma. We revealed that the percentage of intestinal type tumour (ITT) increased with advancing age (52% in patients less than 60 years compared to 73% of octogenarians (P less than 0.001)). The male:female ratio was 1.7 for ITT versus 1.3 for diffuse type tumour (DTT (P = 0.12)). ITT was more common in proximally (fundus) localized tumours than in distal lesions (77% vs 65%; P less than 0.05). The proportion of patients with ITT decreased with advancing stages of the disease (70% in stage I and II vs 52% in stage IV (P less than 0.0001)). More patients with DTT had tumour infiltration in the resection margin (21% vs 9%; P less than 0.001). Intestinal metaplasia was found in 48% of those with ITT compared with 28% of those with DTT (P less than 0.001). No association was found between Lauren's classification and the ABO blood group or between the tumour types and infiltration in lymphatic or blood vessels. We conclude that gastric adenocarcinoma occurs in at least two different biological forms and that differentiation between the two is of relevance for treatment.

Adult↗
PubMed1991

The risk of cancer at all sites following gastric operation for benign disease. A cohort study of 4,224 patients.

This report represents the results of a historical cohort analysis of 3,360 males and 864 females who had a gastric resection or gastroenterostomy for benign disease between 1990 and 1969. Within the period 1970 to 1988 the cohort was cross-checked with the data files at the Cancer Registry of Norway to identify the patients in whom cancer had been diagnosed. When analyzed according to cancer sites, increased risk was recorded for the oropharynx, stomach, colon, pancreas, liver, biliary tract, larynx, lungs, urinary bladder and non--melanomatous cancers of the skin in males. In females, increased risk was only observed for the oropharynx, but was close to a statistically significant level also for cancer of the stomach. A lower number of tumors of the central nervous system than expected was observed in both males and females. The increased risk of cancer of the lungs, larynx and urinary bladder in males can be regarded as evidence of the high prevalence of smokers in the cohort. We suggest that the increased risk of cancer of digestive organs is mainly related to life-style factors, particularly tobacco-specific nitrosamines whose effect is enhanced by surgical sequelae.

Cohort Studies↗