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Erik Fosse

Publications and source records attributed to Erik Fosse.

29 records · Page 2Linked to original sources
PubMed2003

[Transcatheter closure of atrial septal defects in the oval fossa].

BACKGROUND: We report five years' experience with transcatheter closure of defects in the oval fossa at Rikshospitalet University Hospital in Oslo, Norway. MATERIAL AND METHODS: We reviewed the results in 69 patients between 1.3 and 74 years of age (median 5.3), weighing median 20 kg (7.8-109), with pulmonary blood flow 2.40.74 (1.3-4.8) times systemic flow, and median diameter of the defect 18 mm (9-34). The patients were followed clinically for one year. RESULTS: In 69/77 (90%) the defect could be closed. None had a significant residual shunt. One patient showed a very small residual leak after one year. Two children, not yet seen after one year, had a small shunt after one month. The complication rate has been low, and we have not been able to demonstrate any sequelae. The hospital stay is two nights without any convalescence period. The results compare favourably to surgery. INTERPRETATION: The method was efficient and safe in all age and weight groups. The very limited total volume of such procedures indicates they should be centralised and only carried out by a small number of physicians.

Adolescent↗
PubMed2003

Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery.

BACKGROUND: Coronary artery bypass surgery with cardiopulmonary bypass carries a significant risk of perioperative brain injury. At least 1% to 5% will suffer a stroke, and at 3-months postoperatively approximately 30% are reported to have cognitive impairment assessed by neuropsychologic testing. In off-pump surgery cardiopulmonary bypass is not used and instrumentation on the ascending aorta is reduced. The main aim of this study was to assess if off-pump surgery reduces intraoperative cerebral embolization. METHODS: This was a prospective and randomized study of two comparable groups with regard to age, sex, years of education, preoperative cognitive functioning, and surgical characteristics. Fifty-two patients (29 off-pump) were monitored by the use of transcranial Doppler ultrasound for cerebral microembolization during surgery. Preoperative and postoperative clinical, cerebral magnetic resonance imaging, and neuropsychologic examinations were also carried out. RESULTS: There was a significant reduction in the number of cerebral microemboli during off-pump compared with on-pump surgery (16.3 [range 0 to 131] versus 90.0 [range 15 to 274], p < 0.0001). No significant difference with regard to the incidence of neuropsychologic performance (decline in 29% off-pump, 35% on-pump) or neuroradiologic findings at 3 months was found, and there was no association between the number of cerebral microemboli and cognitive outcome. CONCLUSIONS: This study clearly demonstrates that off-pump surgery leads to a reduction in intraoperative cerebral microembolization. A significant reduction in the number of off-pump patients with cognitive decline or ischemic brain lesions on cerebral magnetic resonance imaging could not be demonstrated in this relatively small patient population.

Aged↗
PubMed2003

Acceptable short-term results after endovascular repair of diseases of the thoracic aorta in high risk patients.

OBJECTIVE: To report our experience with endovascular stentgraft repair of diseases of the descending thoracic aorta in high risk patients. METHODS: Twenty-one procedures were performed in 20 patients (10 women), aged 22-81 years, for disease of the descending thoracic aorta with the Gore Excluder thoracic endoprosthesis (WL Gore) (n=11) and the Talent LPS Stent Graft System (Medtronic AVE) (n=10). All patients were considered high operative risk. Diagnoses included saccular aneurysm, aneurysm rupture, mycotic aneurysm, penetrating atherosclerotic ulcer, aortic dissection and aortitis. The access vessels were a tube graft of the (thoraco-) abdominal aorta (n=4), the common iliac (n=6) and the common femoral artery (n=11). Several patients needed major cardiovascular surgery for concomitant disease during the same stay. Computed tomography scan and chest X-ray was performed at 3 and 6 months and thereafter every sixth month postoperatively. RESULTS: Two patients died. One had a colon perforation 8 days postoperatively and died after 3.5 months, and the other with preoperative sepsis and a mycotic aneurysm died on day 11 from cardiac and renal failure. In one patient the stentgraft dislocated during release, and an additional stentgraft had to be implanted 1 week later to treat the proximal leak. In another patient the stentgraft could not be released from the introducer, and was pulled back to the aortic bifurcation and retrieved through laparotomy. Eighteen patients have been followed for 1-24 months, and no migration, wire fractures or endoleak have been seen. There were no neurologic complications. One patient treated for infected pseudoaneurysm had a chronic graft infection. CONCLUSION: In this small number of patients with high operative risk, short-term results of endovascular stentgraft repair of variable diseases of the descending aorta have been satisfactory. Stentgraft repair could be a valuable supplement to surgery for patients with complex multilevel or multiorgan disease.

Adult↗
PubMed2002

[Laparoscopic resection of the liver].

BACKGROUND: Liver resection performed by open surgery is standard treatment in selected patients with liver tumours. Recently, laparoscopic resection of the liver has been reported to be safe, with possible advantages to the patients such as reduced discomfort and shorter hospital stay. In this report we describe our preliminary experience with laparoscopic liver resection. MATERIAL AND METHODS: 32 liver resections were performed in 19 patients during 23 procedures; i.e., four patients had repeated resections. Indications were colorectal metastases (15 patients), focal nodular hyperplasia (two patients), liver cyst (one patient) and metastasis from malignant melanoma (one patient). Three left lobectomies were done, the other resections were partial resections. RESULTS: Median duration of surgery was 187 minutes. Perioperative bleeding was median 650 ml. Tumour tissue was found in the resection margin in one patient and in three patients the resection margin was shorter than 1 mm. No procedures were converted to open resection. Median postoperative hospital stay was 3.5 days. Need of opioids were median 1 day. There was no 30 day mortality. INTERPRETATION: Laparoscopic liver resection is safe in selected patients, but randomized trials between open and laparoscopic resections are necessary.

Adult↗
PubMed2002

[Endovascular stent-graft repair of abdominal aortic aneurysm].

BACKGROUND: Endovascular stent-graft repair of abdominal aortic aneurysms was introduced in 1991. Long-term results from randomised studies are still not available. Aneurysm ruptures after stent-graft repair have been reported, and there has been a considerable need for redo procedures. MATERIAL AND RESULTS: At Rikshospitalet in Oslo, Norway, 26 stent-graft implantations for abdominal aortic aneurysms were performed during the years 1996-2000, two of which were primary technical failures immediately converted to open repair. During follow-up, two patients have died from unrelated causes after six and 12 months. Eight patients were converted to open repair 8-50 months (median 31) after implantation. Indications for conversion were migration (n = 4), increasing aneurysm diameter (n = 3) and rupture (n = 1). Of the 14 patients still under observation, six have had one or more endovascular interventions (a total of 10) for failing graft. INTERPRETATION: Continuous technology development has been used as an argument to postpone randomised studies, as improved results are expected with new generations of stent-grafts. There is a need for discussion of the strategy for the further use of endovascular repair of abdominal aortic aneurysm.

Aged↗
PubMed2002

A virtual environment for surgical image guidance in intraoperative MRI.

Intraoperative MRI has recently entered the operating room as a new imaging modality. Customized visualization systems might further facilitate the use of this imaging technology. A visualization system for use in the interventional MRI has been developed, providing a virtual environment for surgical navigation using real-time images and for controlling the scanner. The visualization system has customized features for certain clinical applications. A training and testing facility has also been established. The introduction of the visualization system in the interventional MRI overcame several ambiguities and inconsistencies that were previously present, and resulted in a more transparent man-machine interface approach. A pilot study using the software to place cryoprobes in an animal liver showed promising results. Augmentation of real-time MR images with 3D rendering and customized navigation features opens new possibilities in intraoperative MRI. The described system can also be extended to other intraoperative imaging modalities.

Humans↗
PubMed2002

The importance of intraoperative angiographic findings for predicting long-term patency in coronary artery bypass operations.

BACKGROUND: The quality of anastomosis is the cornerstone in coronary artery bypass operations. Intraoperative coronary angiography confirms graft patency with the possibility to revise graft failure. The aim of this study was to describe the lesions found at "on-table" angiography, and to evaluate the significance of these immediate angiographic findings for the long-term patency. METHODS: A total of 57 grafts (42 left internal mammary artery grafts and 15 saphenous vein grafts) in 45 patients who underwent off-pump coronary artery bypass operations were included. On-table angiography was carried out with fixed angiographic equipment installed in the operating room. Follow-up angiographies were performed at 3 months and at 12 months. RESULTS: The most frequent finding in an on-table angiogram was spasm, which was not present at follow-up. Out of nine kinks, only one developed into a significant stenosis at follow-up. Of 44 grafts that were normal on-table, 37 (84%) were normal at the follow-up. Of 11 grafts with significant lesions on-table, eight (73%) were normal at the follow-up. Five percent of the grafts were revised because of the on-table angiography. CONCLUSIONS: On-table angiograms can be occasionally difficult to interpret because not all findings are important for later patency. Optimal results on-table predict good long-term results with a negative predictive value of 0.84, whereas significant lesions on-table have less impact on the follow-up results because the positive predictive value was only 0.38.

Adult↗
PubMed2002

Transcatheter closure of atrial septal defects in the oval fossa: is the method applicable in small children?

We report our experience from 1996 through 1999, representing our initial experience with use of the Amplatzer device to close atrial septal defects. Of 46 patients taken to the catheter laboratory with the intention to close the defect, the device was permanently implanted in 40 (87%). They were aged between 1.4 and 71.8 years, with weights ranging from 7.8 to 90 kg. Both age and weight distributed into two peaks, demonstrating two different populations. The size of the devices, taking the biggest device if two were inserted, was between 9 and 30 mm. We underwent a short learning curve, but the time required for fluoroscopy, or the number of difficulties experienced, showed no connection with the size or age of the patient, nor the size of the defect itself. A suspicion that young age and small size would increase the risk and difficulties, and result in more interrupted procedures, could not be substantiated. In children no interruption was procedural. Our early experience, therefore, demonstrates that an experienced interventional team can use the Amplatzer occluder successfully to close atrial septal defects in patients of all ages and sizes, at least from 7.8 kg and up.

Adolescent↗
PubMed2002

A tutorial platform suitable for surgical simulator training (SimMentor).

BACKGROUND: The introduction of simulators in surgical training entails the need to develop pedagogic platforms adapted to the potentials and limitations provided by the information technology. As a solution to the technical challenges in treating all possible interaction events and to obtain a suitable pedagogic approach, we have developed a pedagogic platform for surgical training, SimMentor. METHODS: In SimMentor the procedure to be practiced is divided into a number of natural phases. The trainee will practice on one phase at a time, however he can select the sequence of phases arbitrarily. A phase is taught by letting the trainee alternate freely between 2 modes: 1: A 3-dimensional animated guidance designed for learning the objectives and challenges in a procedure. 2: An interactive training session through the instrument manipulator device designed for training motoric responses based on visual and tactile responses produced by the simulator. The two modes are interfaced with the same virtual reality platform, thus SimMentor allows a seamless transition between the modes. RESULTS: We have developed a prototype simulator for robotic assisted endoscopic CABG (Coronary Artery Bypass Grafting) procedure by first focusing on the anastomosis part of the operation. Tissue, suture and instrument models have been developed and integrated with a simulated model of a beating heart comprises the elements in the simulator engine that is used in construction a training platform for learning different methods for performing a coronary anastomosis procedure. CONCLUSION: The platform is designed for integrating the following features: 1) practical approach to handle interactivity events with flexible-objects 3D simulators, 2) methods for quantitative evaluations of performance, 3) didactic presentations, 4) effective ways of producing diversity of clinical and pathological training scenarios.

Anastomosis, Surgical↗