Acta chirurgica Scandinavica最新文献

One woman (aged 20) and two men (aged 57 and 29, respectively) presented with various urinary and abdominal symptoms, all of which were found at operation to have been caused by anterior sacral meningoceles. All three recovered uneventfully, though the woman was left with some residual numbness of the thigh. Anterior sacral meningocele is a rare condition in which a dural sac herniates into the pelvic region through a congenital defect in the sacrum. Since 1837 182 cases have been reported, and most of them presented with gastroenterological or urogenital signs and symptoms. We have reviewed their symptomatology, pathogenesis and treatment.

Sixty-five patients with late radiation-induced proctitis who presented after a median latency of 13 months (range 6 months to 43 years) were studied retrospectively. As a result of progression new colorectal injuries had occurred in 53 patients (82%): stricture (n = 33), fistula (n = 19) and perforation (n = 1). Fourty-one patients had progression of their lesions to the small bowel or urinary tract. Only seven patients had no progression of their radiation injuries after the initial episode proctitis. Surgery was required in 15 patients with strictures, in 18 patients with fistulas, and in one patient with perforation. Thirty-two patients were managed conservatively. Fifteen patients died, given an overall radiation induced mortality of 23%. Factors significantly influencing mortality were coexisting injuries of the small bowel or urinary tract. Age, stage of primary malignant disease, and previous laparotomy did not influence outcome. After a median observation period of 11 years, 35 patients were alive, of whom 18 (51%) had a fair outcome; 12 continued to have slight or moderate symptoms (34%) and five disabling symptoms (14%). Ten patients had died from unrelated causes, and five from recurrent cancer. Because radiation-induced proctitis is likely progresses, it can not be characterised as a harmless manifestation of late radiation injuries.

The ability of perioperative short-term antibiotic prophylaxis to reduce the predictive significance of nutritional indicators for postoperative infections was evaluated in 162 patients undergoing major surgery for gastric or colorectal cancer. All patients were randomly assigned to a group receiving such prophylaxis or a group with postoperative antibiotic treatment. Preoperative serum albumin, total iron-binding capacity and weight loss were the nutritional indicators, and the evaluation included delayed hypersensitivity response. Postoperative infections occurred in 29% of the total series, with highest incidence in the group with postoperative antibiotics (p less than 0.001) and in anergic patients (p less than 0.05). Increased risk of postoperative infection was related also to the number of altered nutritional indicators (p less than 0.005). Multiple logistic analyses showed that the short-term prophylaxis independently contributed to fall in the infection rate and reduced the prognostic importance of nutritional and immunologic factors. Indeed, heightened incidence of postoperative infection was found only when all three nutritional factors were altered.

Abdominal wall defects created in Sprague-Dawley rats were repaired with either polypropylene mesh (PPM), expanded polytetrafluoroethylene patch (PTFE) or polyglycolic acid mesh (PGA). Tensiometric studies of abdominal wall strength showed that PPM and PTFE provided a strong repair, but that the fibrous response induced by PGA was insufficient to produce a strong support for abdominal wall reconstruction. The size of the overlap at the interface between the abdominal wall fascia and prosthetic material has a greater effect on wound strength with expanded PTFE than with PPM. This is because of the different pattern of collagen infiltration into each material.

The records of all autopsies performed at two major Danish hospitals in 1986 were reviewed in order to analyze cases of fatal pulmonary embolism. There were 2,609 hospital deaths and 1,603 post mortem examinations. Pulmonary embolism was the primary cause of 74 deaths, 16 of which were postoperative. The median age of these ten men and six women was 72 years. In nine of the 16 cases the prognosis would have been favorable had embolism not occurred. Only three of the 16 had received thromboembolic prophylaxis. Four of the deaths from embolism occurred less than 24 hours after surgery, five within 7 days and seven between postoperative days 7 and 30. The estimated incidence of fatal pulmonary embolism following surgery was 1.2-1.3 per thousand.

A 34-year-old man and a 71-year-old woman underwent radical removal of mediastinally sited chondrosarcoma, presumably originating in the periosteum of the vertebral body. The man (with mesenchymal chondrosarcoma) died of remote metastasis 6 years postoperatively. The woman (poorly differentiated chondrosarcoma, grade 2-3) is still alive 2 years after the operation.

Using a new experimental model of protein-calorie starvation, the impact of malnutrition on liver regeneration, and the changes in liver composition during malnutrition and regeneration, were studied. Forty-one rats were allocated to one of 3 groups: group I (n = 13) were normally nourished rats which underwent partial hepatectomy, group II (n = 16) were semistarved rats which underwent partial hepatectomy, and group III (n = 12) were normally nourished rats which underwent sham operations. Liver biopsy specimens were taken at the time of partial hepatectomy and when the rats were killed after 48 hours of regeneration. The samples were used for determination of water, fat, glycogen, protein, DNA, and RNA content. The replication rate of liver cells was measured by autoradiography after continuous incorporation of tritium labelled thymidine. Malnutrition was associated with a higher postoperative mortality and a reduced rate of regeneration. The livers changed during malnutrition with a reduction in both size and glycogen concentration. After 48 hours of regeneration there was a marked change in liver composition with severe fatty degeneration, a fall in glycogen and a rise in water content. RNA concentration was stimulated during regeneration, but during malnutrition the protein content decreased. The results emphasise the importance of an adequate nutritional state for liver regeneration.

Venous calf pump function was evaluated with special reference to distribution and severity of deep venous reflux at different levels. A combination of ultrasonography, foot volumetry and venous plethysmography was used in 100 consecutive patients, 32 of whom were also studied with phlebography and intravenous pressure measurements. A clear relationship was found between clinical stage of chronic venous insufficiency and number of segments with reflux. Clinically important deep venous insufficiency was found particularly in patients with reflux in the distal posterior tibial veins, even in the presence of competent popliteal valves. The results demonstrated the calf pump to be functionally divided into a series of pumps, with the distal part more important than the proximal. The importance of evaluating venous valvular function at different levels for adequate assessment of venous calf pump function is emphasized.

A 28-year-old woman, gravida 1, para 0, presented with toxemia, abruptio placenta and disseminated intravascular coagulopathy. Rupture of the liver with hypotension and oliguria occurred 36 hours after a stillbirth. The patient died of multiple organ failure 9 days after delivery.

Thyroid tissue was collected from 60 patients during operations for various thyroid conditions. The tissue's angiogenic capacity was assessed in a chick chorioallantoic membrane preparation. Angiogenic activity was observed in 22 (85%) of 26 solitary follicular neoplasms, in none of ten papillary carcinomas and in one of seven glands with Graves' disease (all pretreated with propranolol). Of 17 glands with euthyroid multinodular colloid goitre, three (18%) showed angiogenic activity. No angiogenic activity was detected in normal thyroid tissue from 26 patients. Angiogenic activity of diseased human thyroid does not seem to be a marker of thyroid malignancy.