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Biomedical subjects

Jacob Rosenberg

Publications and source records attributed to Jacob Rosenberg.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Treatment of gallstone pancreatitis in Denmark].

INTRODUCTION: The aim of the study was to describe the treatment of gallstone pancreatitis in Denmark and to compare it to the recommendations given in the National Reference Programme for the treatment of patients with gallstone disease. MATERIALS AND METHODS: A questionnaire was sent to the 42 general surgical hospital departments in Denmark. RESULTS: All of the departments returned the questionnaire. All of them treated patients with gallstone pancreatitis; 40 of them performed laparoscopic cholecystectomy. The severity of gallstone pancreatitis was estimated in 29 departments. In patients with mild gallstone pancreatitis, 6 departments used ERCP in the evaluation of choledocholithiasis. In patients with mild gallstone pancreatitis who did not undergo an ERCP procedure with sphincterotomy, 13 departments performed laparoscopic cholecystectomy during the same admission after an acute attack. DISCUSSION: In agreement with the recommendations given in the National Reference Programme, the majority of Danish surgical departments used laparoscopic cholecystectomy in the treatment of patients with gallstone pancreatitis who had not undergone ERCP with sphincterotomy. To avoid the high recurrence of gallstone pancreatitis, laparoscopic cholecystectomy during the same admission is recommended. This recommendation was, however, followed by less than half of the surgical departments.

Acute Disease↗
PubMed2005

[Effect of laparoscopic cholecystectomy on the quality of life of patients with uncomplicated socially disabling gallstone disease].

INTRODUCTION: The indication for cholecystectomy in symptomatic, uncomplicated gallstone disease varies in the literature, and there is no international consensus. In Denmark, laparoscopic cholecystectomy is recommended for patients with uncomplicated cholecystolithiasis and socially disabling pain. Postoperative health-related quality of life on this indication is unknown. MATERIALS AND METHODS: A prospective consecutive study was conducted. Patients with uncomplicated cholecystolithiasis and socially disabling pain were included and underwent laparoscopic cholecystectomy in the department of day surgery. All patients had uncomplicated gallstone disease. An internationally validated questionnaire, the Gastrointestinal Quality of Life Index (GIQLI), was completed one week before and six weeks after the operation. The questionnaire comprises 32 questions covering five items related to gastrointestinal disease, and each question is rated on a scale of 0 to 4 points. The maximum GIQLI score (GIQLI total) is 128 points (32 x 4 points) and represents the best possible health-related quality of life. RESULTS: 75 consecutive patients (62 women) underwent uneventful operations. All patients returned the pre- and postoperative questionnaire. The median age was 42 years (range 18-69), the median body mass index was 26 (19-39) and the median operation time was 56 minutes (24-130). The median GIQLI total scores were 99 (33-127) and 112 (82-128) before and after operation, respectively (P < 0.001). Scores on all five sub-items were significantly improved as well. CONCLUSION: Laparoscopic cholecystectomy improves the health-related quality of life six weeks after the operation in patients with socially disabling, uncomplicated cholecystolithiasis.

Adult↗
PubMed2005

ECG changes during endoscopic retrograde cholangio-pancreatography and coronary artery disease.

OBJECTIVE: Myocardial ischaemia has been described during endoscopic retrograde cholangio-pancreatography (ERCP), but the pathogenesis remains unclear. The aim of the present study was to evaluate whether coronary artery disease was present in patients with ST-segment changes during ERCP. MATERIAL AND METHODS: Forty patients were monitored with a Holter tape recorder during ERCP. Patients with ST-segment deviation during ERCP subsequently underwent a standard exercise ECG test. RESULTS: Twelve patients developed signs of myocardial ischaemia during ERCP (30%) and 9 had concomitant tachycardia. None had a cardiac history or cardiorespiratory symptoms. Ten of the 12 patients did an exercise test and one patient developed silent ischaemia. Subsequent coronary angiography showed no evidence of coronary artery disease. CONCLUSIONS: No signs of existing coronary artery disease were found in patients developing ST deviation during ERCP when evaluated with a 12-lead exercise ECG test. Further studies should evaluate other mechanisms responsible for myocardial ischaemia during ERCP.

Adult↗
PubMed2005

From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis.

OBJECTIVE: The pathogenesis and risk of chronic pain after cholecystectomy are unknown. In this prospective study of 150 consecutive patients undergoing laparoscopic cholecystectomy, the preoperative clinical data, cold pressor test, state of neuroticism and early postoperative pain intensity were assessed. MATERIAL AND METHODS: Follow-up questionnaires were sent to all patients 1 year after surgery. Patients with moderate/severe chronic pain were interviewed and invited to participate in a structured examination programme. RESULTS: The questionnaire response rate was 100%. Twenty patients reported moderate or severe chronic pain. The 1-year in-office interview revealed that two patients without chronic pain had misinterpreted the questionnaire. Sixteen patients were enrolled for the examination programme. Demonstrable pathology explained the aetiology of chronic pain in 8 patients (5%); another 8 patients with moderate (n=6) or severe (n=2) chronic pain were without pathological findings. In total, 132 patients had no chronic pain. Chronic pain patients suffered significantly more intense acute postoperative pain compared with those without chronic pain (p < or =0.05). The incidence of chronic pain patients was higher in the group of patients with intense acute postoperative pain than in patients with low acute postoperative pain (p = 0.030-0.063). Development of chronic pain was not statistically related to a preoperative cold pressor nociceptive stimulus, preoperative state of neuroticism or to any other variables examined. CONCLUSIONS: The risk of significant chronic pain after laparoscopic cholecystectomy for symptomatic cholecystolithiasis is low but was significantly associated with the intensity of acute postoperative pain. Patients should be carefully examined to exclude somatic causes of chronic pain after laparoscopic cholecystectomy.

Acute Disease↗
PubMed2005

Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study.

BACKGROUND: Laparoscopic colonic surgery has been claimed to hasten recovery and reduce hospital stay compared with open operation. Recently, enforced multimodal rehabilitation (fast-track surgery) has improved recovery and reduced hospital stay in both laparoscopic and open colonic surgery. Since no comparative data between laparoscopic and open colonic resection with multimodal rehabilitation are available, the value of laparoscopy per se is unknown. METHODS: In a randomized, observer-and-patient, blinded trial, 60 patients (median age 75 years) underwent elective laparoscopic or open colonic resection with fast-track rehabilitation and planned discharge after 48 hours. Functional recovery was assessed in detail during the first postoperative month. RESULTS: Median postoperative hospital stay was 2 days in both groups, with early and similar recovery to normal activities as assessed by hours of mobilization per day, computerized monitoring of motor activity assessed, pulmonary function, cardiovascular response to treadmill exercise, pain, sleep quality, fatigue, and return to normal gastrointestinal function. There were no significant differences in postoperative morbidity, mortality, or readmissions, although 3 patients died in the open versus nil in the laparoscopic group. CONCLUSION: Functional recovery after colonic resection is rapid with a multimodal rehabilitation regimen and without differences between open and laparoscopic operation. Further large-scale studies are required on potential differences in serious morbidity and mortality.

Activities of Daily Living↗
PubMed2005

Chronic pain and recurrence after laparoscopic inguinal herniorrhaphy.

Chronic pain after open inguinal herniorrhaphy is a complication with an incidence of 10-20% and recurrence in 2-5% of the patients. We here present our experience with the laparoscopic technique. Patients who had undergone laparoscopic inguinal herniorrhaphy (TAPP) in our department from 1995 to 2002 received a questionnaire (N = 161). Patients were asked whether they had chronic pain or recurrence; if so, they were seen in the outpatient clinic. A total of 146 patients responded to the questionnaire (91%). Chronic pain was found in 6 patients (4%) and recurrence in 2 patients (1.4%); 134 patients (92%) had previously had inguinal herniorrhaphy with an open procedure (all Lichtenstein) on the same side. Of these, 105 (78%) preferred the laparoscopic procedure. Laparoscopic inguinal herniorrhaphy led to a very low incidence of chronic pain and recurrence compared with previous reports in open surgery. The majority of our patients were operated on for recurrent hernias, after which an even lower incidence of chronic pain and fewer recurrences in laparoscopic primary herniorrhaphies could be expected.

Adult↗
PubMed2005

The effect of thoracic epidural analgesia on the occurrence of late postoperative hypoxemia in patients undergoing elective coronary bypass surgery: a randomized controlled trial.

STUDY OBJECTIVES: To evaluate the effect of perioperative thoracic epidural analgesia followed by postoperative epidural analgesia compared with conventional IV anesthesia on the occurrence of late postoperative hypoxemia in patients undergoing elective coronary bypass graft (CABG) surgery. DESIGN: Randomized controlled trial. SETTING: Cardiac surgery unit at a university hospital. PATIENTS: A total of 50 patients undergoing elective CABG surgery. INTERVENTION: Patients were randomly assigned to receive either conventional IV anesthesia (CON) or general anesthesia combined with thoracic epidural anesthesia followed by postoperative epidural analgesia (TEA) with bupivacaine. Postoperatively, the patients were monitored in the surgical ward with a pulse oximeter for a total of two postoperative nights (the second and third postoperative nights). MEASUREMENTS AND RESULTS: The overall incidence of episodic hypoxemia was 56% (28 of 50 patients) on the second postoperative night and 89% (41 of 46 patients) on the third postoperative night. More than 30 episodes of hypoxemia developed on the second night in 22% of patients (11 of 50 patients), and on the third night in 30% of patients (14 of 46 patients). Despite oxygen therapy, 7% of patients (3 of 46 patients) experienced constant hypoxemia on the third night. In general, hypoxemia seemed to be slightly worse on the third postoperative night compared with the second postoperative night. Significantly more patients in the TEA group (25 of 25 patients) experienced episodic hypoxemia on the third postoperative night compared with the CON group (16 of 21 patients; p < 0.05). Otherwise, there were no significant differences between the two regimens. CONCLUSIONS: Both episodic and constant hypoxemia were common in the late postoperative period in patients on the ward after CABG surgery with no clinically significant intergroup differences. Thus, perioperative epidural anesthesia/analgesia combined with postoperative epidural anesthesia/analgesia was not protective against hypoxemia, and therapy with opioids did not seem to be of importance for the occurrence of late postoperative hypoxemia on nights 2 and 3 after CABG surgery.

Aged↗