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Biomedical subjects

L Bergdahl

Publications and source records attributed to L Bergdahl.

At least 37 records · Page 2Linked to original sources
PubMed1980

Long-term results after repair of coarctation of the aorta by patch grafting.

Six patients who had been operated upon for coarctation of the aorta with patch grafting between 1958 and 1960 were followed for a minimum of 17 years. One of these patients received an aortic homograft patch for an abdominal coarctation and was in excellent health 21 years later. An aortogram showed no aneurysm formation. One other patient was reoperated upon 1 month after the primary operation because of a pseudoaneurysm. The remaining four patients received either a Dacron graft (three patients) or an Orlon graft (one patient), and they all developed an aneurysm in the aortic wall opposite the patch graft. Three of these patients successfully reoperated upon, but the fourth patient died 17 years after patch grafting because of rupture of the aneurysm. Microscopy (in three patients) showed varying degrees of degenerative changes in the aortic wall opposite the patch. There was no evidence of infection or foreign body reaction in these parts of the aortic walls. The reason aneurysms develop after patch grafting probably is that part of the circumference is replaced by a material with tensile characteristics differing from those of the aorta itself. Repair of aortic coarctations with synthetic patches therefore cannot be recommended.

Adolescent↗
PubMed1980

Benign tumors of the papilla of Vater.

Benign tumors of the papilla of Vater are unusual; fewer than 100 cases have been reported. Six cases with adenomyosis of the papilla of Vater are presented. In two patients, the adenomyosis was an incidental finding at laparotomy or autopsy. In two patients, adenomyosis produced symptoms, and the lesions were successfully excised. There was no recurrence of biliary symptoms postoperatively. In two patients adenomyosis was associated with adenocarcinoma of the papilla of Vater. Adenomyosis can be a premalignant condition. Frozen section for histologic examination should be done when a tumor is encountered in the papilla of Vater. Adequate local excision of a benign tumor should result in cure. The patient must, however, be followed-up carefully, and a reexploration should be performed if there is the slightest indication of recurrence. The recurrence is often malignant.

Adenocarcinoma↗
PubMed1980

Helifix, an electrode suitable for transvenous atrial and ventricular implantation.

The Helifix endocardial fixation lead can be screwed in between the trabeculae of the right ventricle or the right atrial appendage. The lead was used for ventricular stimulation in 30 patients. In seven of them, the Helifix electrode was used because of dislocation of other leads and in eight patients because acceptable threshold levels could not be obtained with other electrodes. In six patients the Helifix lead had to be inserted in the proximal part of the right ventricle and in one patient in the outflow tract. One patient required replacement of the Helifix lead after 6 weeks because of an excessive threshold rise. There was only one instance of electrode dislodgment (1 hour after implantation) in the 30 patients. In 20 patients the Helifix lead was implanted in the right atrial appendage with the aid of a new double stylet. There was no instance of electrode dislodgment or any other complications in the 20 patients. The Helifix lead is therefore recommended as an atrial electrode. This lead is also suitable in patients with frequent dislocations and for better fixation to other parts of the right ventricle than the apex.

Aged↗
PubMed1979

Surgical treatment of aneurysms of the ascending aorta: early experience with the sinus-shaped composite dacron graft.

This paper reviews the early and late results of 36 operations for aneurysms of the ascending aorta. Cystic medial necrosis was the predominant cause of aneurysm formation (56%), followed by arteriosclerosis (25%), previous aortotomy (11%) and syphilitic aortitis (8%). Dissection was encountered in 42%. The ascending aorta was replaced by a tubular Darcron graft in 26 patients, whereas 10 underwent aneurysmorrhaphy. Additional procedures were aortic valve replacement (27), resuspension of the aortic commissures (4) and coronary ostial implantation into sinus-shaped composite Dacron graft (4). Hospital mortality (0--18 days) was 8/36 patients (22%), but higher with cystic medial necrosis (30%), dissection (33%), duration of ECC greater than 180 minutes (38%), graft replacement (44%), emergency operation (45%) and heart volume greater than 900 ml/m2 BSA (50%). Late mortality (average 3 years) was 29%, but higher with cystic medial necrosis (33%), following aortic valve replacement (36%) and during anticoagulation (47%). Late cumulative survival (average 3 years) was 47% for the entire series, but only 33% in the presence of cystic medial necrosis. The poor overall prognosis for patients with cystic medial degeneration was closely related to a high incidence of fatal anastomotic complications and late deaths from cerebral haemorrhage during anticoagulation. Radical exclusion of the diseased aortic wall and omission of long-term anticoagulation are therefore desirable in order to lower the mortality rate. Surgery concerns the aneurysm per se, the aortic incompetence and the coronary ostia. The sinus-shaped composite graft with a Björk-Shiley prosthesis at its base appears to be a promising device for such a procedure, which should be performed electively, following early diagnosis in order to prevent dissection and emergency operations.

Adolescent↗
PubMed1979

Successful replacement of the aortic valve, mitral valve and ascending aorta with re-implantation of the coronary arteries.

A 63-year-old man was operated upon with replacement of the aortic valve, mitral valve and ascending aorta with re-implantation of the coronary arteries. A composite graft with a 27 mm Björk-Shiley tilting disc prosthesis was inserted with 3 continuous Prolene sutures in the aortic position. The coronary arteries were thereafter re-implanted in holes made in the graft. A 31 mm Björk-Shiley valve was sutured in the mitral position with about 20 isolated mattress sutures of Ti-Cron. Selective myocardial hypothermia was instituted with Ringer's solution of 4 degrees C. The total perfusion time was 185 min compared with 240 and 275 min in two previously reported, similar cases. We consider that the use of cardioplegia, a composite graft and continuous sutures makes it possible to reduce the operation time in these complex cases. Our patient is in good condition 9 months postoperatively.

Aortic Aneurysm↗
PubMed1979

Intrathoracic goitre: a review of 29 cases.

Twenty-nine patients suffering from intrathoracic goitre who were admitted to a thoracic surgical clinic were studied. Most patients had respiratory complaints but as many as 28% did not have any symptoms and their goitres were revealed on routine chest X-rays. Only seven patients were operated upon with a thoracic approach, usually a sternal split. All others were operated upon with a cervical collar incision. Three of the goitres were toxic and one malignant. Two of the patients died, one when inducing anaesthesia and the other of pulmonary embolism six days after the operation. General anaesthesia with endotracheal intubation is preferred when operating for intrathoracic goitre. The operation is started with a cervical collar incision and the patients prepared for a sternal split. Lateral thoracotomy may be necessary only when the mass is situated in the posterior mediastinum.

Aged↗
PubMed1978

Cystosarcoma phyllodes in young women.

A total of eight cases of cystosarcoma phyllodes in women under 25 years of age were reported to the Swedish Cancer Registry during a ten-year period (1960 to 1969). Only one of these tumors was malignant. It was successfully treated with simple mastectomy and postoperative radiation therapy. Of the remaining seven cases, six were treated with local excision of the lesion and one with simple mastectomy. In no case, did the tumor recur during a follow-up of an average of ten years. Local excision seems to be sufficient for the benign form of the tumor, whereas simple mastectomy is indicated for the malignant form. Radical mastectomy is indicated only of the tumor has invaded the pectoral fascia. The tumor rarely metastasizes to the axillary lymph nodes.

Adolescent↗
PubMed1978

Coarctation of the aorta. The world's longest follow-up.

A 32-year follow-up of the first coarctations of the aorta ever operated upon in the world has shown a systolic blood pressure below 155 mmHg in 12 of 18 patients and a diastolic blood pressure below 95 mm Hg in 15 of 18 patients. No gradient over the anastomosis was noted in 13 of 18 patients when measured by a cuff and in 5 of 12 patients when measured by catheterization. If the diameter of the anastomosis was 75% of that of that of the aortic arch, only a very small or no resting gradient was found. If there was no gradient at rest, there was usually only an insignificant or no gradient during exercise. A small gradient at rest was always higher during exercise, depending on the degree of work load, length of narrowed segment and aneurysm at the suture line. There was an incidence of 44% aortic valvular disease and of 20% degenerative changes in caput femoris. The anastomosis had grown with the patient.

Adolescent↗
PubMed1978

Acute appendicitis in patients over sixty.

In an investigation of 68 consecutive patients over the 60 operated on for acute appendicitis in 1969--1972 the symptoms and signs did not differ notably from those in younger patients. However, the disease was more advanced in the elderly patients with perforation of the appendix in 49%. Postoperative complications occurred in about one third of the series, but were never fatal. Use of broad-spectrum antibiotics (ampicillin) is recommended. The investigation showed that it is possible to reduce the mortality from acute appendicitis in elderly patients to a level comparable to that in younger ones.

Acute Disease↗
PubMed1977

Hyperparathyroidism in thyrotoxicosis.

The frequency of hypercalcemia in 295 patients treated for thyrotoxicosis was 2 per cent. The combination of thyrotoxicosis and hyperparathyroidism is rare and only twenty-seven well documented cases could be found in the literature. Among ninety-two patients operated on for hyperparathyroidism, ten of them had thyrotoxicosis. In the present study, data on thirty-seven patients are reported. Hypercalcemia was found in all the patients and four of them had acute hyperparathyroidism. Hypophosphatemia was recorded in 60 per cent and hypercalcuria in 75 per cent of the patients. In ten patients there were renal concretions. Skeletal roentgenograms showed abnormalities in 65 per cent of the patients. In no instance had hyperparathyroidism commenced before thyrotoxicosis. Other recent reports on the etiology of hyperparathyroidism are discussed and it is concluded that hyperparathyroidism in thyrotoxicosis is a secondary disease. If a thyrotoxic patient with hypercalcemia still has elevated calcium values when becoming euthyroid after thyrostatic treatment, an operation should be performed. Because of a high recurrence rate in such patients with adequate follow-up, "near total parathyroidectomy" is recommended.

Adult↗
PubMed1977

Differentiation of acute hyperparathyroidism from severe hypercalcemia of malignancy.

Acute hyperparathyroidism should be distinguished from severe hypercalcemia of malignancy. In the former condition parathyroidectomy is often of vital importance; in the latter, the malignant neoplasm should be treated surgically or with radiation or cytostatics. The differential diagnosis is sometimes difficult because some patients with acute hyperparathyroidism have coexisting carcinoma elsewhere. Two patients subjected to parathyroidectomy because of severe hypercalcemia secondary to malignant neoplasms are described and compared with twelve similar cases from the literature. In patients with severe hypercalcemia medical treatment should always be tried first. If acute hyperparathyroidism cannot be excluded, subtotal parathyroidectomy should be performed after medical preparation.

Diagnosis, Differential↗