[Treatment of gallstones in Denmark].
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Cholecystectomy↗
Biomedical subjects
S Schulze
Publications and source records attributed to S Schulze.
Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery: comparison between carbon dioxide pneumoperitoneum and gasless laparoscopy.
HYPOTHESIS: Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery. DESIGN: Prospective randomized trial. SETTING: Department of Surgery in a university hospital. PATIENTS: Twenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N = 17). INTERVENTIONS: Patients were randomized to either gasless (n = 9) or conventional CO2 (n = 8) surgery. MAIN OUTCOME MEASURES: Intraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted. RESULTS: Descending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO2 group (P=.009). Central venous pressure, PaCO2 inspiration pressure, and end tidal CO2 level were significantly higher in the CO2 group (P = .05, .03, .04, and .01, respectively). Patients in the CO2 group had less pain during mobilization and coughing (P = .008 and .006, respectively), and were significantly more fatigued (P = .04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function. CONCLUSION: No clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO2 or gasless laparoscopy for colonic disease.
Aged↗
Dipole source analysis in persistent mirror movements.
To elucidate the pathomechanism underlying persistent mirror movements (MM), we modelled the origin of electric brain activity associated with these movements. Movement-related cortical potentials (MRCP) in a group of subjects affected by persistent mirror movements were compared with those of a control group. The data of the normal subjects were best explained with two bilaterally active electric sources in the sensorimotor cortices with a clear preponderance of the hemisphere contralateral to the movement. In contrast, the MM subjects presented a fairly symmetric source activity in both hemispheres during unilateral intended movements. In the control group, the source representing the activity of the motor cortex ipsilateral to the moving finger reduced activity before the beginning of the movement; this was interpreted as an inhibition of the ipsilateral motor cortex during unilateral movement. In the MM group, however, this inhibition was not seen. Furthermore, while normal subjects demonstrated no relevant activity of an additional source placed near midline motor structures (supplementary motor area; SMA), subjects with MM showed considerable activity of this dipole source. These findings suggest that subjects with persistent MM have abnormal bilateral activation of the primary motor areas, probably together with an additional activation of mesial motor structures. This assumption fits well with the observation of an incomplete decussation of the pyramidal tract. The bilateral activation is then explained as a compensatory strategy in order to achieve sufficient force in the innervated target muscles.
Adolescent↗
IgE levels in surgery: effect of ranitidine and prednisolone.
BACKGROUND: Immunoglobulin E (IgE) is important in allergic reactions and in host defense against parasites. IgE may also participate in the acute-phase response to physical stress. This study aimed to determine whether major abdominal surgery induced increased serum IgE levels, and whether treatment with ranitidine or prednisolone influenced the IgE response to surgery. METHODS: For assessment of the IgE response to surgery and the effect of ranitidine, 24 patients scheduled for major abdominal surgery were randomized to receive either perioperative treatment with ranitidine or no treatment. To evaluate the effect of glucocorticoids, 24 patients undergoing major elective abdominal surgery were randomized to receive preoperative treatment with either prednisolone or placebo. IgE levels were determined in serum samples drawn pre- and postoperatively. RESULTS: In the ranitidine study, both the control group and the ranitidine-treated group displayed a postoperative increase (P<0.001) of serum IgE. In the prednisolone study, a postoperative increase (P<0.05) of serum IgE was detected in the placebo group. No significant increase was found in the prednisolone-treated group. CONCLUSIONS: Major abdominal surgery induces an increase of serum IgE. This increase can be prevented by preoperative treatment with prednisolone, but not with ranitidine.
Adult↗
Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy.
OBJECTIVE: To evaluate the effect of supplementary oxygen on heart rate and arterial oxygen saturation during colonoscopy. DESIGN: Controlled study. SETTING: Two university hospitals, Denmark. SUBJECTS: 40 patients having colonoscopy. INTERVENTIONS: 20 patients were given supplementary oxygen through nasal prongs (2 L/min), and 20 patients breathed room air during colonoscopy. All patients were given conscious sedation and were monitored with a pulse oximeter during colonoscopy. MAIN OUTCOME MEASURES: Tachycardia (pulse rate>100 min(-1)) and arterial oxygen desaturation (SpO2<90%) during colonoscopy. RESULTS: There were no differences in the incidence of tachycardia or mean heart rate during endoscopy between the two groups, and no patient developed symptomatic cardiac arrhythmias or hypotensive episodes. 10 patients in the room air compared with none in the oxygen treatment group (p = 0.0004) had one or more episodes during which arterial oxygen saturation fell below 90% during colonoscopy, and mean oxygen saturation was higher in the oxygen treatment group than in the room air group (p < 0.001). No clinical complications occurred in either group. CONCLUSION: Hypoxaemia and tachycardia are common during routine colonoscopy. The use of supplemental oxygen prevented hypoxaemia, but had no significant effect on heart rate.
Adult↗
Changes in plasma potassium concentration during carbon dioxide pneumoperitoneum.
Hyperkalaemia with ECG changes had been noted during prolonged carbon dioxide pneumoperitoneum in pigs. We have compared plasma potassium concentrations during surgery in 11 patients allocated randomly to undergo either laparoscopic or open appendectomy and in another 17 patients allocated randomly to either carbon dioxide pneumoperitoneum or abdominal wall lifting for laparoscopic colectomy. Despite an increasing metabolic acidosis, prolonged carbon dioxide pneumoperitoneum resulted in only a slight increase in plasma potassium concentrations, which was both statistically and clinically insignificant. Thus hyperkalaemia is unlikely to develop in patients with normal renal function undergoing carbon dioxide pneumoperitoneum for laparoscopic surgery.
Adolescent↗
Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blinded, placebo-controlled study.
UNLABELLED: Pain is the dominant complaint after laparoscopic cholecystectomy. No study has examined the combined effects of a somato-visceral blockade during laparoscopic cholecystectomy. Therefore, we investigated the effects of a somato-visceral local anesthetic blockade on pain and nausea in patients undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3 postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain for the first three postoperative hours (P < 0.01) but had no apparent effects on intraabdominal or shoulder pain. During the first 3 postoperative h, morphine requirements were lower (P < 0.05), and nausea was reduced in the ropivacaine group (P < 0.05). Throughout the first postoperative week, incisional pain dominated over other pain localizations in both groups (P < 0.01). We conclude that the somato-visceral local anesthetic blockade reduced overall pain during the first 2 postoperative h, and nausea, morphine requirements, and incisional pain were reduced during the first 3 postoperative h in patients receiving prophylactic multi-modal analgesic treatment. IMPLICATIONS: A combination of incisional and intraabdominal local anesthetic treatment reduced incisional pain but had no effect on deep intraabdominal pain or shoulder pain in patients receiving multimodal prophylactic analgesia after laparoscopic cholecystectomy. Incisional pain dominated during the first postoperative week. Incisional infiltration of local anesthetics is recommended in patients undergoing laparoscopic cholecystectomy.
Abdominal Pain↗
[Care of a child with leukemia. Infections are particularly dreaded].
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Antineoplastic Agents↗
[Nothing new under the sun?].
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Cholecystectomy↗
DNA isolation from recalcitrant materials such as tree roots, bark, and forest soil for the detection of fungal pathogens by polymerase chain reaction.
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DNA, Fungal↗
[The effect of prednisolone on the systemic response and wound healing after colonic surgery].
To study the effect of preoperative treatment with a single high-dose of glucocorticoid on the systemic and immunological response, wound healing, and convalescence after colonic surgery, thirty patients were double-blind randomized to receive either methylprednisolone 30 mg/kg intravenously 90 minutes prior to induction of anaesthesia (group 1, n = 12), or to receive placebo (group 2, n = 12). Six patients were excluded from the study. Assessments of pain, pulmonary function, convalescence, various injury and wound-healing factors were done until 10 days after surgery. Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activation was significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effect on collagen accumulation. It is concluded that treatment with a single high dose of glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.
Anti-Inflammatory Agents↗
Hypoxaemia and myocardial ischaemia during colonoscopy.
BACKGROUND: Myocardial ischaemia (defined as ST-segment deviation on electrocardiogram (ECG)) may occur during colonoscopy, but the pathogenic mechanisms are unknown. We have evaluated the occurrence of arterial hypoxaemia, tachycardia, and myocardial ischaemia during routine colonoscopy. METHODS: Eighteen patients underwent colonoscopy under conscious sedation and without supplementary oxygen. Arterial oxygen saturation was measured by continuous pulse oximetry, and ECG was monitored continuously with a Holter tape recorder during the procedure. RESULTS: Arterial oxygen desaturation and tachycardia were common during colonoscopy and occurred in 45% and 35% of patients, respectively. Two patients developed signs of myocardial ischaemia during the colonoscopy: one case of ST depression (1.7 mV) and one case of ST elevation (4.3 mV). In both patients the ST deviation disappeared when the colonoscope was retracted. Myocardial ischaemia occurred in both patients simultaneously with tachycardia, and in one of these arterial hypoxaemia was also present. CONCLUSIONS: Myocardial ischaemia occurs during routine colonoscopy, but with a lower incidence than previously reported during upper endoscopy. Myocardial ischaemia during colonoscopy may be associated with tachycardia and/or hypoxaemia. Further studies should clarify the relative role of tachycardia, hypoxaemia, and viscerocardiac reflexes in the pathogenesis of myocardial ischaemia during colonoscopy.
Adult↗
[Prevention and health promotion in future young families].
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Adult↗
[Metoprolol prevents myocardial ischemia during endoscopic retrograde cholangiopancreatography].
The aim of our study was to evaluate the effect of metoprolol on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. Thirty-eight (2 x 19) patients scheduled for endoscopic cholangiopancreatography received either metoprolol 100 mg or placebo two hours before endoscopy. During endoscopy, arterial oxygen saturation was measured by continuous pulse oximetry, and the electrocardiogram was monitored continuously with a Holter tape recorder. Myocardial ischaemia was defined as an ST segment deviation > 1 mV from baseline. Heart rate during endoscopy was significantly lower in the metoprolol group compared with the placebo group (p = 0.0002). Twenty-one patients (16 placebo versus five metoprolol, p = 0.0008) developed tachycardia (heart rate > 100/min) during the procedure. A total of eleven patients (ten placebo versus one metoprolol, p = 0.003) developed myocardial ischaemia during the procedure, and myocardial ischaemia was always related to increases in heart rate. In conclusion, metoprolol prevented myocardial ischaemia during endoscopic cholangiopancreatography, probably through a heart rate lowering effect. Thus, tachycardia seems to be a key pathogenic factor in the development of myocardial ischaemia during endoscopy.
Adrenergic beta-Antagonists↗
[Effect of sublingual nitroglycerin on pain following ERCP].
Nitroglycerine, acting a nitric oxide donor, is known to relax visceral smooth muscle. We report a case where pain associated with pancreatitis after ERCP was successfully treated with sublingual nitroglycerine 0.5 mg. The analgesic effect lasted approximately two hours. Further controlled studies should evaluate the effect of nitroglycerine on pain associated with pancreatitis as well as clarify the mechanisms involved.
Administration, Sublingual↗
Spatio-temporal frequency domains and their relation to cytochrome oxidase staining in cat visual cortex.
Spatial and temporal frequencies are important attributes of the visual scene. It is a long-standing question whether these attributes are represented in a spatially organized way in cat primary visual cortex. Using optical imaging of intrinsic signals, we show here that grating stimuli of different spatial frequencies drifting at various speeds produce distinct activity patterns. Rather than observing a map of continuously changing spatial frequency preference across the cortical surface, we found only two distinct sets of domains, one preferring low spatial frequency and high speed, and the other high spatial frequency and low speed. We compared the arrangement of these spatio-temporal frequency domains with the cytochrome oxidase staining pattern, which, based on work in primate striate cortex, is thought to reflect the partition of the visual cortex into different processing streams. We found that the cytochrome oxidase blobs in cat striate cortex coincide with domains engaged in the processing of low spatial and high temporal frequency contents of the visual scene. Together with other recent results, our data suggest that spatiotemporal frequency domains are a manifestation of parallel streams in cat visual cortex, with distinct patterns of thalamic inputs and extrastriate projections.
Animals↗
[Time used in monitoring of postoperative oxygen status].
The purpose of the study was to compare use of time with pulse oximetry versus arterial blood gas measurement on the general surgical ward. Eighty patients who had just had major orthopaedic or abdominal surgery were included in the study at two hospitals in Copenhagen. Success rate for pulse oximetry was 100% but only 89% for arterial blood gas measurement, because the laboratory did not analyse samples where the ice surrounding the syringe had melted when arriving at the laboratory or if there were air bubbles in the blood sample. At Hvidovre Hospital the results from the blood gas analysis were delayed median 58 minutes compared with 32 minutes at Sundby Hospital (p < 0.001). The delay at Hvidovre Hospital was largely due to prolonged time for transportation of the sample from the surgical ward to the laboratory by the hospital porter. No patient had hypercapnia or acid-base disturbances requiring treatment. With pulse oximetry reliable monitoring of arterial oxygenation can be obtained non-invasively and with a high success rate. Furthermore, the results are available for the clinician immediately compared with arterial blood gas measurement, where there is a delay in getting the results. We recommend that all general surgical wards should have a portable pulse oximeter for monitoring arterial oxygenation after major surgery.
Adult↗