Acta chirurgica Scandinavica最新文献

The effects on hemostatic and thromboprophylactic mechanisms of intravenous desmopressin (DDAVP, 0.3 micrograms/kg) and dextran 40 and 70 given both separately and in various combinations were evaluated in five male volunteers. Dextran did not inhibit the DDAVP-induced hemostatic changes. The dextran-induced decrease in platelet adhesiveness and the prolonged bleeding time were totally reversed by DDAVP. Hematocrit decrease was seen after both drugs, lasting longer when they were combined. We conclude that DDAVP and dextran may be used concomitantly, each with maintained beneficial properties. DDAVP will still act hemostatically by increasing platelet adhesiveness, factor VIII and von Willebrand factor and by shortening the dextran-induced prolongation of bleeding time. Dextran and DDAVP may even have additive antithrombotic effects due to the DDAVP-induced stimulation of the fibrinolytic activity, which is not inhibited by dextran, and to rheologic changes such as hematocrit decrease induced by both drugs.

The aim of this study was to investigate the oxygenation of the gastrointestinal tract mucosa using indirect pH measurements in a porcine septic model (intravenous infusion of live E. coli). By means of intraluminally placed balloon catheters (Tonomitior) permeable to CO2, intramucosal pH (pHi) was calculated using the Henderson-Hasselbalch equation. Cardiopulmonary hemodynamics and portal blood flow were measured using Swan-Ganz catheters. Samples were taken from the gastrointestinal tract for histological examination. Nine pigs were given i.v. E. coli infusion while six pigs served as sham controls and were given an equivalent amount of Ringer's solution only. All septic animals developed hemodynamic signs of septic shock. Gastric, small intestinal and sigmoid colonic pHi decreased gradually during the four hour observation period. In the small intestine and the sigmoid colon the decrease was significant already after one hour (p less than 0.01 and p less than 0.02, respectively). Microscopic examination of tissue specimens obtained 4 hours following induction of sepsis revealed normal or close to normal findings in all the sham and in more than half of the septic animals. These findings indicate that abnormally low gastrointestinal intramucosal pH may be found early in septicemia, preceding microscopically detectable damage by several hours. It is concluded that the tonometer technique does provide early detection of gastrointestinal ischemia in septic shock.

A case of bilateral necrosis of the femoral head, following aorto-bifemoral vascular bypass, is reported. The necrosis of the femoral heads might be explained by a temporary obstruction of the lateral blood supply peripheral to the arteria profunda femoris, due to an increased joint pressure caused by regional oedema with joint effusion and swelling of the joint capsule.

A 43-year-old man presented with a retroperitoneal mass, the histological examination of which showed well developed spleen parenchyma with a capsule and fibrous tissue in between normal looking splenic cells. Postoperative 99mTc sulphur colloid scans of his liver and spleen were normal. This is, to our knowledge, the first reported case of an ectopic spleen in the left retroperitoneal space.

An effort has been made to study possible delaying factors in the diagnosis and primary treatment of breast cancer. The data are based on 273 female patients, referred to the Department of Oncology, Lund, constituting 50% of all primary breast carcinomas without a previous malignancy diagnosed in 1986 in a catchment area of 1.2 million. Of these, 68% initially consulted a general or private practitioner, whereas only 21% directly consulted surgical departments. The interval from the initial consultation to operation, analysed multivariately, was correlated to the number of referral-steps (13 vs. 75 days), the category of physician initially consulted (15 vs. 33 days), and the outcome of a combined positive or negative mammography + aspiration cytology (13 vs. 58 days). If one or both of these diagnostic procedures were negative, the delay varied considerably between the four categories of physicians initially consulted. The median time between decision and start of radiotherapy was 38 days, constituting 46% of the time from the initial consultation to start of this treatment modality.

Mesorectal lymph-node involvement in rectal cancer may be detected by endosonography as a hypoechoic lesion, but false positives are a problem. We report a new method, using transrectal ultrasound-guided core biopsy, for verifying metastatic growth in a mesorectal lymph node detected by endosonography at postoperative follow-up for low rectal cancer.

Ten patients undergoing abdominal operations had oxygen saturation (SpO2) and transcutaneous (PtcO2) and subcutaneous (PscO2) oxygen tensions monitored continuously during the second and third postoperative nights from 11 pm to 7 am. At the end of the second postoperative night an oxygen stimulation test (10 l/min by face mask) was carried out in eight of the 10. Median SpO2 was 91% (range 82-95) on the second, and 91% (86-95) on the third, postoperative nights, respectively. Six patients had intermittent episodes of desaturation to less than 80%, each of less than one minute's duration. PtcO2, but not PscO2, followed the episodic variations in SpO2. PscO2 was 58 mmHg (46-69) on the second postoperative night and 61 mmHg (48-71) on the third postoperative night. PscO2 correlated with SpO2 in all but one patient who had lower PscO2 than expected from the measured SpO2 and estimated PaO2. Oxygen treatment increased individual PscO2 by 14 mmHg (9-49), PtcO2 by 38 mmHg (10-104), and SpO2 to 99% (95-100), but stable PscO2 was not achieved within the 20 minute period of treatment. These results obtained during continuous measurements show pronounced intersubject differences in oxygen tensions near the surgical wound in the late postoperative period. The results suggest that pulmonary oxygenation is the most important determinant of mean subcutaneous oxygen tension after uncomplicated elective abdominal operations.

To evaluate the various operations for caecal volvulus we reviewed 48 patients who were treated between 1948 and 1989. Six were treated conservatively (the volvulus resolved before operation), and the remaining 42 patients (43 operations) were treated by untwisting (n = 14, 2 early deaths); caecopexy (n = 13, no deaths); caecostomy (n = 3, 2 early deaths); or resection (n = 13, one early death). At follow up a mean of 11.8 years later (range 0.4 to 34) the numbers of patients who had remained free of symptoms were 6, 5, 1 and 9, respectively. We conclude that resection gives the best long term results with acceptable mortality and morbidity and should be the treatment of choice for caecal volvulus.

Duodenocaval fistula is exceedingly rare. Penetrating trauma, gunshot wounds and toothpick perforation of the duodenum are known aetiological factors. Two recent case reports have implicated radiation-induced ulceration of the duodenum. We describe the first case of duodenocaval fistula resulting from a giant peptic ulcer of the descending duodenum.