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Biomedical subjects

T Gerner

Publications and source records attributed to T Gerner.

At least 19 recordsLinked to original sources
PubMed1990

[Abdominal injuries after blunt trauma].

We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.

Abdominal Injuries↗
PubMed1990

[Grading and prognosis of blunt abdominal injuries].

From 1 January 1980 to 31 December 1987, 297 patients were admitted to Ullevål Hospital, Dept. of Surgery, with abdominal injury after blunt trauma. The Injury Severity Score (ISS) was determined in retrospect, and correlated to mortality, morbidity and use of resources. 50 patients (16.8%) died. Mortality increased with increasing ISS, until ISS was above 34. In this group, mortality was 75%. In the survivors, hospital costs (days in the hospital, in the intensive care unit, on mechanical respiration, and number of blood units transfused) increased with increasing ISS. The likelihood of developing septicaemia adult respiratory distress syndrome (ARDS) or multiple organ failure also increased with increasing ISS. Those who died were older and had a higher ISS than the survivors. In patients over 55 years old, the mortality increased significantly. The ISS is well suited for identification of seriously injured patients after blunt abdominal trauma. The ISS can be used to predict mortality, morbidity and cost of treatment in groups of patients.

Abdominal Injuries↗
PubMed1990

[Delayed surgery in blunt abdominal trauma].

Abdominal organ injuries caused by blunt trauma are notoriously difficult to diagnose, and for this reason an operation may be dangerously delayed. 426 abdominal organ injuries were registered in a series of 331 patients admitted after blunt abdominal trauma. 151 of these patients had 199 abdominal organ injuries which required surgical repair. In 31 patients (20%) with 44 organ injuries, operation was delayed for more than six hours after admission, in most cases because of missed diagnosis. One of these patients died as a result. Hollow viscus injuries were the most commonly missed. In addition to repeated clinical evaluation, peritoneal lavage, repeated if necessary, and diagnostic imaging must be used as valuable tools of diagnosis, especially in comatous patients, in patients with multiple injuries, and in intoxicated patients.

Abdominal Injuries↗
PubMed1990

[Penetrating abdominal injuries].

We have reviewed the medical records of 111 patients treated for abdominal stab wounds during the period 1980-87. Our two hospitals serve a catchment area of about 450,000 people. Exploratory laparotomy was performed in 89 patients with suspected peritoneal penetration. In 16 patients the laparotomy was negative, and in 15 patients only minor injuries were noted. There were no serious complications in these 31 patients. Twenty-seven patients had thoracic wounds below the fourth intercostal space, 15 with intraabdominal injuries. The most common injuries were lacerations of the liver, the small bowel and the diaphragm. The mortality in the series was 2%. Stab wounds are infrequent in Norway, and most surgeons have limited experience of such injuries. We discuss whether to employ immediate exploratory laparotomy or selective management when the peritoneum has been penetrated. When there is no evidence of evisceration or omental protrusion, local exploration of the wound should be performed in order to confirm or exclude peritoneal penetration. Injury to the diaphragm and intraabdominal viscera should always be suspected in thoracic stab wounds below the fourth intercostal space.

Abdominal Injuries↗
PubMed1990

[Diagnostic peritoneal lavage in blunt abdominal trauma].

Peritoneal lavage was performed in 142 of 331 patients submitted to hospital after blunt abdominal trauma. The lavage catheter was introduced through a short infra-umbilical longitudinal incision with surgically controlled access to the peritoneal cavity. First time lavage was positive in 58 out of 68 patients in demand of laparotomy, and after repeated lavages in 66 of 68. In 12 patients there was a false positive lavage. The sensitivity was 97% and the specificity 84%. Negative lavage strongly indicates that laparotomy is not necessary. A positive test as an indication for laparotomy should be regarded with reservation. The method is simple to perform and represents a valuable supplement to clinical evaluation in patients with blunt abdominal trauma.

Abdominal Injuries↗
PubMed1989

[Duodenal injuries due to blunt trauma].

UNLABELLED: During the last ten years we have seen fourteen patients with duodenal injury after blunt trauma. Five patients with intramural hematomas received no treatment. Nine patients had a perforated duodenal wall, and in four of these the diagnosis was delayed for more than 24 hours. Revision and primary suture were carried out in seven patients, with no complications. In one patient, where the diagnosis was delayed for three days, the perforation was closed around a Pezzer catheter for external drainage. She developed an intraabdominal abscess which required reoperation. One patient died from liver injury with profuse bleeding; the others survived without sequelae from the duodenal injury. CONCLUSIONS: Duodenal injuries are rare and early diagnosis is difficult. We think that frequently repeated physical examinations, liberal use of diagnostic peritoneal lavage, and careful peroperative exploration of the entire duodenum when performing laparotomy after abdominal injuries, are important for early diagnosis and treatment.

Abdominal Injuries↗
PubMed1989

[Diathermy in surgery].

Unskilled handling of surgical diathermia units exposes patients, operators and assistants to unnecessary risks. This article briefly reviews the equipment's technical potential, possible risks of complication, and how risk factors can be eliminated by proper handling. Important issues are risk of local accidental burns and of unintended stimulation of muscles and nerves, precautions when treating patients with a pacemaker or metallic implant, and specific problems connected to endoscopy.

Electrocoagulation↗
PubMed1989

[Surgical treatment of pancreatic injuries].

Major pancreatic traumas are not frequent, and diagnosis often difficult. In a retrospective study we found 11 verified cases of pancreatic trauma treated in the period 1977-86. Three were penetrating and eight blunt trauma victims. Five patients suffered serious lesions in other organs. Laparotomy was performed in nine patients. One patient died, due to other lesions. The patients can be separated clinically into two groups. In the first group emergency laparotomy is indicated because of bleeding or peritonitis, most often due to lesions in other abdominal organs. In the other group the initial symptoms and clinical signs are sparse, and the diagnosis is based on repeated clinical examinations, ultrasound CT, peritoneal lavage and repeated amylase determinations. Contusions and minor lacerations without injury to the duct are treated with revision and canalization. Resection and pancreatico-jejunostomy should be considered when the pancreas is heavily lacerated with damage to the duct system.

Adolescent↗
PubMed1989

Human immunodeficiency virus and hepatitis B virus in injured patients and victims of violence.

Of a total number of 643 injured patients admitted during 1986 and 1987, 113 were tested for antibodies against the human immunodeficiency virus (HIV) and hepatitis B surface antigen HBsAg and the concentration of hepatitis B surface antibodies (HBsAb) was determined. Nine patients were HIV positive while HBsAg was detected in two patients and increased levels of HBsAb were found in 19 patients. HIV antibodies were found in 6 (4.8 per cent) of 124 victims of violence, in 3.3 per cent of the patients with penetrating injuries and 1.1 per cent of the patients with multiple, closed injuries. The estimated prevalence for HIV infection in the Norwegian population is 0.08 per cent, thus indicating an over-representation of infected patients among injured patients and victims of violence.

Emergencies↗
PubMed1989

Serotonin--a possible transmitter for the gastric adaptive relaxation. Interaction with histamine and prostaglandin F2 alpha on pressure responses in the isolated stomach.

Serotonin, or 5-hydroxytryptamine (5-HT), relaxes upper guinea pig stomach, and its possible role as a transmitter in the vagally induced upper gastric adaptive relaxation has been discussed. Such a transmitter is expected to act via other mechanisms than crude muscle depression. To test whether the relaxation response to serotonin is compatible with a putative role as transmitter in gastric adaptive relaxation, we wanted to evaluate whether serotonin acts by crude muscle depression and whether it selectively inhibits histamine or prostaglandin F2 alpha (PGF2 alpha). The study shows that 5-HT, in addition to its relaxatory effect on fundic spontaneous activity, selectively inhibits histamine, whereas PGF2 alpha is not inhibited. It is then concluded that the relaxatory effect of 5-HT is provided through other mechanisms than crude muscle depression and that selective inhibition of intramural agonists, like histamine, is a possible effect mechanism.

Animals↗
PubMed1989

Antibiotic prophylaxis in colorectal surgery. Combined doxycycline-tinidazole vs. doxycycline alone.

Single-dose doxycycline was compared with single-dose doxycycline + tinidazole in regard to prevention of septic complications after colorectal surgery, taking into account the type and level of surgery--right or left hemicolectomy, rectal operations and others. The study was performed as a prospective double-blind trial, with randomization in blocks. In colorectal surgery as a whole the combination was found to be more effective than doxycycline alone. When the four surgical blocks were separately considered, however, the difference between the two regimens was found to be mainly due to rectal operations, following which the incidence of abdominal and of perineal wound infections was significantly lower with the combined regimen than with doxycycline alone. The subgroups composed of right-sided or left-sided hemicolectomy or other operations were too small to permit definite conclusions.

Adolescent↗