[Extended Danish classification of liver- and bile duct diseases (the DASL-code)].
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Biomedical subjects
Publications and source records attributed to H Baden.
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When asked before admission to hospital 74% of 640 surgical patients suffering from various abdominal diseases stated that they wanted to be told if examinations revealed they were suffering from cancer. A prospective study of 58 patients confirmed this wish and no regrets were noted 3 days and 3 months later. The immediate reactions to information were moderate and almost all patients adjusted well to the situation after a short, varying, initial phase with anxiety. No severe, untoward reactions were seen. In contrast to the traditional attitude in surgical wards this study suggests that generally cancer patients should be given the diagnosis.
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Hepatic lobectomy for primary epithelial cancer was performed in 31 adults from 1964 through 1977 in the surgical departments of six Scandinavian hospitals. Twenty-three patients were discharged and had a 2 year survival rate of 62 per cent and a 5 year survival rate of 16 per cent. Alternatives to surgery have not yet emerged. Further progress requires centralization.
Suturing of bleeding esophageal varices by transthoracic esophagotomy is frequently followed by leakage in the suture line. To avoid this complication we suggest transesophageal suturing without esophagotomy. The technique was evaluated in five normal pigs and applied to two patients with bleeding esophageal varices. Esophagus both in the pigs and the patients tolerated the procedure well and the bleeding from the esophageal varices stopped. We suggest application of this procedure for bleeding esophageal varices instead of emergency portocaval shunt operation.
The value of the erythrocyte sedimentation rate (ESR) as a screening test has been assessed through a retrospective analysis of 1648 surgical patients, in whom this test was not necessary for diagnosis, treatment or evaluation of risk factors. The ESR was inexplicably elevated in 42 patients (2.5%), but a marked increase was found in only very few cases, and in none had this finding been of any consequence for the admission in question. One patient had a malignant disease, which was not diagnosed during hospitalization, but the reasons for this were incorrect interpretation of relevant diagnostic procedures. We conclude that ESR can be excluded as a screening test in surgical patients, when diagnosis and therapeutic measures can be decided by history-taking and physical examination.
The insulin response to oral and intravenous glucose was measured in ten patients after resection of antrum, duodenum, proximal jejunum, and the head of pancreas (Whipple's operation). Compared to matched normal subjects the operation reduced neither the total nor the gut hormone induced part of the insulin response to oral glucose. The results suggest, that hormones from the first part of the intestinal tract are not necessary as incretins.
During barium enema, barium pentrated the rectum to the perirectal extraperitoneal tissue in six patients. Four of these died, and the two survivors have permanent colostomies. The incidence of this rare complication may be further reduced if barium enema is postponed after instrumentation of the rectum, the enema can not lifted more than one meter, the balloon not distended too much, the tip of the balloon catheter made very short, and the personnel in the radiological department made aware of the complication. The complication is probably best treated by prompt diverting colostomy, drainage of perirectal tissue, and antibiotics.
In 105 patients with colorectal cancer, liver metastases were found at extirpation of the primary tumor. The spontaneous survival was a median of 10 months. The intraoperative clinical diagnosis of liver metastases was subsequently confirmed by autopsy in 77 patients, was uncertain in 26, and was proved wrong in two at subsequent celiotomy. The accumulative experience shows that the median survivals range from 6 to 12 months, which is considerably better than in unselected series of liver metastases.
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