Biomedical subjects
Publications and source records attributed to K Brasso.
Polidocanol was instilled in five pleural cavities of three pigs. Adhesions formed in all. Adhesion distribution varied from covering a minor part to most of the lung, depending on the amount of polidocanol. One control cavity treated with sodium chloride was unaffected. Microscopy showed fibrous bridges between the pleural layers and mild submesothelial fibrosis and inflammation.
The Danish Prostatic Symptom Score (DAN-PSS-1) comprises 12 questions related to voiding problems in benign prostatic hyperplasia. The patient himself scores each symptom as regards severity (symptom score) and impact on daily life (bother score). The precision of this patient-weighted (postal) questionnaire was investigated in terms of repeat frequencies of replies from 197 randomly selected men on two sequential occasions. The questionnaire was well understood by the patients. The median frequency of repeat in answers to the questions was 83.5% (range 0-99.7%). This frequency depended on the nature of the question and the severity or bother of the symptom. Repeatability as regards bother rose markedly when the bother score was made dependent of the symptom score, suggesting a relationship between the two. As with other questionnaires, the precision of those dealing with prostatism should be established before clinical use. The observed relationship between symptom score and bother score may be of diagnostic value.
One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one was cured by percutaneous ethanol injection and one was reoperated and cured in another hospital. Three patients with persistent hypercalcaemia refused reoperation. Transitory hypocalcaemia with a median duration of 15 days was found in 36 patients, and permanent hypocalcaemia in two patients (1.9%). Permanent paralysis of the recurrent nerve occurred in three patients (2.9%). Twenty-one patients developed other postoperative complications from which they all recovered without sequelae. No postoperative deaths occurred. Our results show that surgical treatment of primary hyperparathyroidism--including bilateral neck exploration and attempted biopsies of all parathyroid glands--is safe with a high cure rate.
Thirty-five patients were examined 6-11 years after operation for torsion of the testis. Loss of testicular tissue was significantly associated with long preoperative duration of symptoms and with low postoperative sperm counts. The sex hormones were normal in the majority of patients but there were significantly higher levels of both FSH and LH in the group of patients with symptoms exceeding 8 hours. There was also a higher prevalence of abnormal semen quality in the same group. Furthermore, FSH and LH levels correlated significantly to the duration of symptoms and correlated inversely to the sperm count and concentration. Measurement of carnitine levels in seminal plasma, as a sign of vas deferens obstruction or dysfunction of epididymis, and of autoantibodies against spermatozoa revealed no significant findings.
Ten patients have been reviewed in whom urethral stents were implanted for treatment of urethral stricture. Their urethral strictures had been treated with a median of 4.2 endoscopic urethrotomies under direct vision without success. The patients were first treated with optical urethrotomy, and dilatation to 30 F--after which the stents were inserted under direct endoscopic control. A total of 12 stents were inserted. All patients had a 30 mm stent inserted first, and two patients had an additional 20 mm stent inserted because of recurrent stricture at the distal or proximal end of the first stent. One patient had a urethrotomy 12 months after insertion of the stent because of a short recurrent stricture at its distal end. The median length of follow up was 24 months. The median preoperative maximum flow rate was 6.5 ml/s, and the median postoperative maximum flow rate was 20.3 ml/s. Half the patients had postmicturition dribbling postoperatively. The stents were covered with epithelium after 6-18 months, most between 12 and 18 months.
Abdominal pregnancy resulting in a liveborn infant is an obstetric rarity in Denmark. A case is reported and four cases reported during the past 20 years are reviewed. In the present case, the diagnosis of extrauterine pregnancy was not established in advance. The infant, a full-term boy weighing 3,650 g, was delivered transplacentally by Caesarean section during epidural analgesia. The placenta was adherent to the intestines and was left in the abdomen for spontaneous resorption but was expelled gradually through an amnio-percutaneous fistula over a period of three months. The infant did not present any evidence of congenital abnormalities.
Parkinson's disease rarely occurs in women of the fertile age. A case in a woman aged 42 is reported. The diagnosis of Parkinson's disease was established three years before her second pregnancy. Medicinal treatment with antiparkinson drugs during pregnancy is briefly discussed.
Gallbladder torsion is a rare surgical emergency occurring primarily in elderly women. The anatomical background is a variation in the attachment of the gallbladder to the inferior margin of the liver. Increasing life span will probably lead to an increasing number of cases, and gallbladder torsion must be kept in mind in patients with sudden onset of pain in the upper right quadrant, nausea, vomiting, and a palpable mass. None of the laboratory routines or non-invasive examinations enables one to make the right preoperative diagnosis. Treatment is cholecystectomy. Promptly treated, the prognosis is good.
Ninety-one cases of emergency herniotomy are reviewed as regards the short- and long-term results. The review shows that immediate surgery does not involve any increased risk to the patient as regards mortality and recurrence rate. The frequencies of bowel resection and mortality are related to the duration of the history and the type of hernia.
Sperm granulomata are rare without prior surgical intervention but constitute a common complication of vasectomy and affect 35 and 42% with the conventional methods. Refertilizing and sperm quality are better in cases of sperm granulomata and, as opposed to previous assumptions, reduced fertility is not found in cases of sperm granulomata in patients with sperm antibodies. Fewer complaints are observed after open end vasectomy despite the particularly high incidence of sperm granulomata. Unfortunately, the literature does not appear to contain randomized investigations as guidelines for the choice of surgical method for vasectomy.
Torsion of the gall bladder is caused by abnormal placement of the gall bladder and is a surgical emergency. A case with a typical history is reported. Treatment is cholecystectomy. Correctly treated, the mortality is less than 3%.
Incarcerated or strangulated groin hernia was treated in 114 patients in 1976-1985. Manual reduction was performed on 23 patients (20%), all younger than 15 years, and was followed by elective herniorrhaphy within 48 hours in all but one case. Three patients with median age 80 years died in the postoperative period. The cumulated recurrence rate after 5 years was 6.2%, which compared well with long-term results after elective herniorrhaphy. The risk of recurrence thus is not an argument for delayed surgery. Taxis is concluded to be the preferred immediate treatment in children, while adults should be operated on without delay.