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Biomedical subjects

B Anderberg

Publications and source records attributed to B Anderberg.

At least 19 recordsLinked to original sources
PubMed1996

Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy.

A prospective study was performed to determine the frequency and type of bile duct abnormalities, and to determine whether routine use of intraoperative cholangiography during laparoscopic cholecystectomy might aid in the prevention of bile duct injuries. Overall, anatomical aberrations of the bile ducts were found in 98 (19 per cent) of 513 cholangiograms. The most common anomalies were at the hepatic confluence and constituted different types of right hepatic subsegmental ducts draining separately into the biliary tree (n = 43, 8.4 per cent), either close to the cystic duct or directly into the cystic duct. Three bile duct injuries (0.5 per cent) occurred during the study period. These results show that routine intraoperative cholangiography is feasible and provides valuable information about the anatomy of the biliary tract, thereby improving the safety of laparoscopic cholecystectomy. If an injury to the biliary tract occurs early during operation, the cholangiogram allows the surgeon to detect the injury, to make a prompt repair and thereby reduce the morbidity associated with a delayed diagnosis. Routine use of intraoperative cholangiography is strongly recommended.

Acute Disease↗
PubMed1995

Laparoscopic groin hernia repair: results of 200 consecutive herniorraphies.

Laparoscopic hernia surgery was introduced in this unit in May 1992. Up to September 1993, 175 patients with 200 inguinal and femoral hernias were treated using this approach. This prospective study deals with intraoperative and postoperative complications, patient recovery and early operative results. The median (range) age was 58 (21-87) years and the median (range) follow-up was 12 (5-24) months. A laparoscopic transabdominal preperitoneal technique was used. The median (range) operation time was 67 (23-160) min for unilateral hernias and the median (range) hospital stay was 1 (0-27) day. Major complications were two postoperative bowel obstructions and seven recurrences, six of these in the first 31 patients. Overall, 17 minor complications were recorded; 52 per cent of the patients were back at work within 1 week, and 94 per cent within 1 month. The value of laparoscopic hernia repair remains to be determined and randomized controlled trials will be necessary.

Adult↗
PubMed1993

Peroperative nitrous oxide does not influence recovery after laparoscopic cholecystectomy.

We have evaluated the effects of nitrous oxide on recovery following laparoscopic cholecystectomy in a prospective, randomised, double-blind study with 42 otherwise healthy patients. All patients received meperidine 1 mg/kg and atropine 6 micrograms/kg im for premedication, and anaesthesia was induced with fentanyl 2 micrograms/kg and thiopental 4-6 mg/kg. Succinylcholine was used for the intubation and muscle relaxation was achieved using vecuronium. Isoflurane with 70% nitrous oxide in oxygen and fentanyl was used for maintenance of anaesthesia in group I (n = 19), and isoflurane in air/oxygen and fentanyl in group II (n = 23). The postoperative ward staff and the surgeon evaluating the postoperative recovery were blinded to the anaesthetic technique. No differences were found in duration of operation and anaesthesia, need for postoperative analgesia or postoperative nausea treated medically. Recovery, judged by the Steward Coma Score, comprehension and collaboration, degree of sedation and orientation in time and space, was similar in the two groups. Postoperative hospital stay was 1 (1-4) day in the nitrous oxide group (median (10-90th percentiles) versus 2 (1-4) days in the air group. The time until patients were recovered, as judged by return to work and normal daily activities, was the same in the two groups: 8 (4-11) days in the nitrous oxide group and 8 (4-11) days in the air group. We conclude that nitrous oxide has no influence on recovery after laparoscopic cholecystectomy.

Adult↗
PubMed1990

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Acute Disease↗
PubMed1989

Preliminary notes on vulnerability of the retina to injury from peripheral laser exposure conditions.

If laser exposures to the periphery of the retina from low-energy lasers cause a hemorrhage obscuring the optical pathway to the fovea, resulting in loss of visual function, the risks for soldiers on the battlefield may be greater than previously expected. Two off-axis experiments were undertaken to obtain an indication of the hazards involved in exposing the peripheral retina to visible laser irradiation. Both off-axis exposures caused immediate vitreal hemorrhages in the periphery. After 80 min, the hemorrhage in the first eye had diminished, and in the other it was significantly smaller than immediately after exposure; even the central hemorrhage was smaller. Another observation after 120 min revealed the same result. These results indicate that an obvious risk exists on the battlefield for peripheral hemorrhages due to lasers operating within the retinal hazard spectrum. However, it is necessary to make more observations to establish the findings firmly.

Animals↗
PubMed1989

Vulnerability of the retina to injury from a military ruby rangefinder at battlefield distances.

This study investigates the possibility of causing a vitreal hemorrhage with a standard ruby rangefinder at battlefield engagement distances when the laser is observed with the naked eye or through magnifying optics or filters. The experiments were undertaken on the eyes of anesthetized pigs. The pigs were anesthetized with Mebumal and given 0.5% thropicamid in the eyes. They were then exposed to the radiation from a standard military ruby rangefinder (pulsewidth 25 ns, pulse energy 180 mJ). The rangefinder was aligned with a He-Ne laser and a beamsplitter. Eight experiments were performed, each with several exposures. The range was varied from 0.5-850 m. Some of the experiments were made using the naked eye, some with a filter, some with binoculars (7 x 50) and some with a combination of filter and binoculars. The pulse energy was varied from 91-6500 muJ. Vitreal hemorrhages were caused at distances of 410 and 850 m when a pair of binoculars (7 x 50) was placed in front of the eyes. The intraocular energy varied between 1500 and 4400 microJ. Results indicate that there is a possibility of causing a vitreal hemorrhage in a soldier who is using standard field binoculars and looking in the direction of an ordinary military rangefinder at distances at least up to 850 m.

Animals↗
PubMed1988

Parastomal hernia in relation to site of the abdominal stoma.

Parastomal hernia is a common late complication of enterostomy, especially colostomy, and sometimes requires surgical treatment. A possible contributory factor, location of the stoma in relation to the rectus abdominis muscle, was studied by examination of 130 patients with permanent intestinal stoma. The bowel had been brought out through the rectus abdominis muscle in 107 patients and lateral to it in 23 patients. The respective prevalence of parastomal hernia in these groups was 2.8 per cent and 21.6 per cent. The highly significant difference indicates that enterostomy should be constructed through the rectus abdominis muscle, not lateral to it.

Abdominal Muscles↗
PubMed1988

Haemorrhagic gastritis. Incidence, etiological factors, and prognosis.

Etiological factors and prognosis were analyzed in 78 patients with haemorrhagic gastritis admitted to an intensive care unit during 8 years. These patients constituted 11.4% of a total of 684 cases with massive upper gastrointestinal haemorrhage admitted during the same time period. The annual incidence of haemorrhagic gastritis was 6.5/100,000 inhabitants. Most frequently, the bleeding episode was associated with intake of alcohol (35%) or anti-inflammatory drugs (23%). Only 4 patients (5%) had classical stress ulcers. Due to massive bleeding, surgery was necessary in 5 patients. Non-resectional surgery was carried out with no postoperative mortality. Six patients (8%) died (age 72-92 years), one as a direct cause of bleeding and five in severe associated disease, haemorrhagic gastritis being more or less a terminal event. Thus, in the great majority of unselected patients with haemorrhagic gastritis bleeding ceases on conservative treatment. In a minor fraction surgical treatment is a last resort but the method of choice is debatable. We propose that gastric resection should be avoided.

Adult↗
PubMed1988

Duration of T-tube drainage after exploration of the common bile duct.

The optimal duration of T-tube drainage after choledochotomy is not known. In a randomized study, comparison was made between early (postoperative day 4) and late (day 7) removal of the T-tube. The evaluation was made on 62 patients, after exclusion of 20 because of retained stones, technically inadequate postoperative cholangiography, cholangitis or failed T-tube removal. The T-tube was removed on day 4 in 28 cases and on day 7 in 34. There were no clinically significant complications, but two patients with early and two with late removal had transient pyrexia. The mean postoperative stay in hospital was significantly shorter for the patients with early T-tube removal (8.2 vs. 9.8 days). The corresponding figures for the patients younger than 50 years were 7.1 vs. 9.1 days and for those older than 50 they were 8.7 vs. 10.1 days--both differences significant. The results indicated that early removal of choledochal T-tube drain does not increase postoperative morbidity and can significantly shorten the hospital stay.

Adult↗
PubMed1988

Endoscopic biliary drainage in malignant bile duct obstruction.

During a four-year period endoscopic biliary drainage (EBD)--preoperative in 25 and permanent in 45 patients--was successfully established without sphincterotomy in 70 out of 89 referred patients (79%) with malignant bile duct obstruction. 51 of the patients had internal stents and 19 external naso-biliary tubes. There was no procedure-related mortality or severe complications such as perforation or bleeding. One patient, however, got a moderate pancreatitis after stent drainage (1%). In the early drainage period (before operation or discharge) the cholangitis rate was 10%, and during the late period (after discharge) it rose to 27% of the patients. 68 of all 70 patients (94%) had a reduction in S-bilirubin concomitant with clinical improvement and 27 of the 45 patients (59%) with permanent drainage became unjaundiced. Recurrent or increasing jaundice occurred, however, in half the number of these patients (23/45) after an average of 89 days; twelve of them had a temporary regression of jaundice after exchange of stents in spite of advanced disease. The use of multiple stents did not reduce the risk of recurrent jaundice or of cholangitis. It is concluded that EBD inserted without sphincterotomy is a safe and efficient non-surgical alternative in the treatment of malignant bile duct obstruction.

Bilirubin↗
PubMed1987

Endoscopic removal of common bile duct stones without subsequent cholecystectomy.

Good results from endoscopic sphincterotomy (EST) for removing choledochal stones following cholecystectomy, have led to increasing use of the method when the gallbladder is in situ. The need for cholecystectomy after successful EST has been questioned. As cholecystectomy in elderly patients involves substantial risk, we routinely defer cholecystectomy in such patients while they remain asymptomatic. Experience of 40 cases is reported. Thirty-four were discharged without cholecystectomy and one underwent elective cholecystectomy at his own request. The remaining 33 patients were followed up for 6-53 (mean 21.5) months. Four died from causes unrelated to gallstone disease. Symptoms requiring cholecystectomy arose in two cases (6%). We found no problems due to refraining from routine elective cholecystectomy following EST for common bile duct stones. The rarity of later symptoms appears to justify a "wait and see" attitude to post-EST cholecystectomy.

Adult↗