Biomedical subjects
H Kjaergård
Publications and source records attributed to H Kjaergård.
[Steristrip Tape suturing compared with percutaneous suturing of abdominal incisions. A controlled study of late cosmetic results].
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Traumatic fixation of the hip by a bolt fired from a bolt gun.
A 25-year-old building worker was struck in the left hip by a 12.7-cm long bolt fired from a bolt gun. The bolt penetrated deeply into the pelvis, through the acetabulum, the joint cavity and the head of the femur leading to fixation of the hip. In spite of immediate extraction of the nail, cleansing, immobilization, antibiotics and tetanus prophylaxis, the wound became infected. The tips of the modern types of nails used in nail guns may be coated with a plastic material which can constitute a troublesome foreign body if left behind, because the nail is merely extracted without opening and exploring the track.
Anaesthesia for colonoscopy. An examination of the anaesthesia as an element of risk at colonoscopy.
The importance of anaesthesia as an element of risk at colonoscopy has been examined retrospectively over a 10-year period from 1975 to 1984. The colonoscopic examinations were made by surgical gastroenterologists and anaesthesiologists working in cooperation. In 1242 cases the patients received diazepam/fentanyl anaesthesia during the colonoscopy (Group I) and in 126 cases they received general anaesthesia (Group II). The incidence of perforations of the large bowel in Group I was 0.8% (95% confidence limits: 0.4-1.5%) and in Group II 0.0% (95% confidence limits: 0.0-2.9%). Statistically the difference is not significant (P = 0.38). The groups were comparable with a view to the patients' age, weight, the duration of the colonoscopy and the number of times that polypectomy had been performed. All anaesthesia was administered by staff qualified by training and experience to administer anaesthesia, and did not cause any complications. However, four patients had vasovagal reflexes due to manipulation of the colonoscope. The dosing in the patients in Group I averaged: diazepam as premedication 9.2 mg, intravenous diazepam 12.4 mg, intravenous fentanyl 0.14 mg, and the duration of the colonoscopy was 36.5 min. The medication and the duration of the colonoscopy did not vary significantly in the patients with perforation of the large bowel. Our conclusion is that diazepam/fentanyl anaesthesia, administered by experienced staff, is harmless, and that general anaesthesia for colonoscopy did not involve an increased risk of perforation of the large bowel.
Follow-up study after colorectal polypectomy. The predictive value of a negative double-contrast barium enema.
In this study the predictive value of a negative double-contrast barium enema for colonic polyps has been calculated as the ratio of the number of true negative radiologic examinations to the total number of negative radiologic examinations. The total number of negative double-contrast barium enemas for polyps of the colon was 357 in 228 consecutive patients with previous or suspected neoplastic colonic polyps examined in the period 1977-84. The predictive value of a negative double-contrast barium enema for all colonic polyps regardless of size was 87% (95% confidence interval, 84-91%). The corresponding predictive value of a negative result for polyps larger than 10 mm in diameter was 98% (95% confidence interval, 97-100%). Polyps that had not been detected by radiography were removed by colonoscopy, and 85% of them were available for histological examination. No cancers were found. The polyps were primarily neoplastic, but metaplastic and juvenile polyps were also ascertained.
Radiation dose in investigations of the large bowel. Comparison of radiation doses in examinations of the colon with double-contrast barium enema with the Welin modification and colonoscopy.
Because of the increasing and repeated application of colonoscopy and double-contrast barium enema with the Welin modification in connection with the checking of patients who have been treated for neoplastic polyps, we have found it valuable to examine the amount of radiation that the patients are exposed to in the two kinds of examinations. The radiation dose in the examination of the colon with the Welin modification (35 examinations) and at colonoscopy (114 examinations) was, on an average, 387 and 10 mSv, respectively. Since colonoscopy gives a possibility not only of diagnosis but also of treatment and also exposes the patients to 40 times less radiation than X-ray examination with the Welin modification, we recommend colonoscopy for diagnosis and treatment of neoplastic colonic polyps.
Multiple stenoses of the small intestine by metastatic spread from breast cancer.
We present a patient who had a left mastectomy for breast cancer and 3 years later developed intestinal obstruction due to metastatic spread to the small bowel. The small bowel follow through showed multiple stenoses of the small intestine leading to a variety of differential diagnostic considerations as metastatic spread from breast cancer to the small intestine has not been convincingly documented so far.
Primary tumours of the small intestine--the diagnostic problem.
The records of 43 patients with 32 malignant and 11 benign neoplasms of the small intestine were reviewed in order to improve early diagnosis. The malignant tumours comprised of 14 carcinoids, 10 carcinomas and 8 sarcomas. The benign tumours constituted 7 different histological types. An increasing frequency of malignant tumours through the bowel was found. Thirty-three per cent of all patients had a sudden onset of symptoms leading to acute explorative laparotomy, whereas the remaining 67 per cent were characterized by a long history. The predominant symptoms were abdominal pain, nausea and vomiting, weight loss and a palpable abdominal mass. An exact preoperative diagnosis was made in 41 per cent of the cases. Upper gastrointestinal X-ray contrast examination with small bowel follow through and ultrasonography gave the greatest sensitivity. A diagnostic strategy was difficult to recommend considering the rarity of these tumours and the low sensitivity of the employed diagnostic modalities. Recently developed Japanese enteroscopes capable of exploring the entire small bowel seem to offer the most promising diagnostic method for the future.
Perforations from colonoscopy during diagnosis and treatment of polyps.
Within a department specialized in surgical gastroenterology 11 perforations of the large bowel occurred over a 10 year period as complication of diagnosis and treatment of polyps by colonoscopy. The incidence by diagnostic colonoscopy was 0.6% (95% confidence interval 0.2-1.3%) and by polypectomy 0.7% (95% confidence interval 0.2-1.8%). Nine of the perforations were located in the sigmoid colon; one occurred retroperitonally in the descending colon. The lesions were from 1-8 cm long and were located in normal bowelsegments. The most important cause of perforation was forceful introduction of the scope and the use of electrocoagulation. The patients were treated by laparotomy and antibiotics. In six cases the operation was initiated within one hour after the perforation had occurred, the remaining 5 were operated on when they developed symptoms 1/2-3 days after the colonoscopy. One patient, a 84-year-old man, died of acute myocardial infarction 4 weeks after the operation.
[A study of 10 years surgical material with the aid of register. Primary tumors of the small intestine].
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[Malignant tumors of the small intestine].
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[The diagnosis of fat embolism syndrome].
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[Bilateral compartment syndrome in a drug addict].
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[Cerebral abscess with atypical findings in computed tomography and a fatal course].
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Impairment of postural stability following perivascular axillary block with mepivacaine.
Perivascular axillary block was performed on 10 patients using a catheter technique. All patients received a standard dose of 50 ml mepivacaine 1% with adrenaline 1:200 000. Using a quantitative Romberg-test performed on a computerized force-plate system, postural stability was tested before and 40 min after the local anesthesia. There was a significant increase in body-sway following axillary block (P less than 0.01). Nine out of 10 patients had an increased sway-tendency, an average of 31%. A proportionate increase in postural imbalance has been found in normal persons after alcohol consumption, when blood levels were 0.8 mg/ml.
Interactions between digoxin and potassium-sparing diuretics.
A kinetic and hemodynamic study of digoxin was performed in six healthy subjects and similar studies were performed during digoxin with spironolactone and with triamterene. Spironolactone reduced renal tubular secretion of digoxin and attenuated its positive inotropic effect (evaluated by systolic time intervals and echocardiography) and triamterene reduced the extrarenal elimination of digoxin, but induced no changes in digoxin-elicited inotrophy. It is suggested that the renal handling of digoxin is influenced by the intracellular potassium concentration in the renal tubular cell. The results indicate a drug-receptor interaction between spironolactone metabolites and digoxin at the hypothetical inotropic digitalis receptor. Amiloride has been reported to suppress digoxin inotropism, whereas spironolactone induces minor inhibition and triamterene does not affect digoxin inotropism.
Amiloride-induced changes in digoxin dynamics and kinetics: abolition of digoxin-induced inotropism with amiloride.
Digoxin dynamics and kinetics were studied in six healthy subjects with and without amiloride. Amiloride increased mean renal digoxin clearance from 1.3 to 2.4 ml . kg-1 . min-1 (p less than 0.001) due to increased tubular secretion of digoxin, while the glomerular filtration rate was unchanged. This might be caused by an increase in intracellular potassium concentration in the tubular cells provoked by amiloride. In contrast, the extrarenal clearance of digoxin was almost blocked by amiloride; it fell from a mean of 2.1 to 0.2 ml . kg-1 . min-1 (p less than 0.025). Total body clearance tended to fall, but the decrease was not statistically significant. EValuation of myocardial contractility by systolic time intervals revealed a concentration-response relationship between digoxin and changes in preejection period index when digoxin was given alone (rs = 0.750, p less than 0.001). Pretreatment with amiloride abolished this relationship (rs = 0.307, p = NS). Blood pressure and echocardiographically determined left ventricular end-diastolic diameter measurements indicated no changes in the left ventricular post- and preload. It is concluded that amiloride suppressed digoxin-induced inotropism.