Acta chirurgica Scandinavica最新文献

Ten patients with non-extirpable adenocarcinoma of the pancreas received monthly subcutaneous implantations of the LHRH analogue goserelin. Subjective improvement (diminished abdominal pain and/or weight gain) occurred within 3 months in seven patients and persisted until about 2 months before death. The treatment was well tolerated by the patients. This preliminary study seems to warrant further investigation of goserelin in the management of pancreatic cancer.

An 84-year-old man presented with multiple non-anastomotic aneurysms in a Dacron axillary femoral graft and coagulopathy. Histological examination and the clinical course suggested that a graft versus host reaction might be the main cause of the aneurysms.

Periarterial and intramural nerves and lymphatics as well as the vascular endothelium may influence pathophysiologic responses to acute arterial occlusion. For study of such pathophysiologic patterns, experimental models resembling the clinical situation are therefore preferable. In this porcine study acute distal aortic occlusion was mimicked by use of a balloon catheter introduced via a vascular graft anastomosed to the lateral aortic wall. Peripheral circulatory disturbance was assessed by measurements of femoral vein blood flow, skin blood flow in the hind foot and oxygen tension in the calf muscle, which verified the degree of ischemia. During the 4-hour ischemic period, repeated arterial and venous blood gas analyses showed increasing acidosis in effluent venous blood from the hind limbs, which after reperfusion slowly normalized. As highly reproducible conditions are achievable with the present experimental model, it can be used for studies of pathophysiologic responses to acute distal aortic occlusion.

A multivariate prognostic index based on clinical data and the results of flow cytometry for the grading of breast cancer was evaluated in 117 patients whose disease had been detected and treated by mastectomy with axillary clearance between 1974 and 1976. Survival analysis with Cox's regression model pointed to three important prognostic factors: lymph node involvement (p less than 0.001), DNA ploidy (p less than 0.01) and tumour size (p less than 0.01). These factors were incorporated into a prognostic index, in which the lymph node involvement, DNA ploidy, and tumour size contributed to the index in that order. Logistic discriminant analysis with five year follow-up as the fixed end point (70 alive, 47 dead) gave the same result; lymph node involvement, tumour size, and DNA ploidy were the best prognostic indicators of survival. The result showed that our multivariate prognostic index was more powerful than lymph node involvement alone. The use of this prognostic index is recommended for selecting patients for different treatments.

Local energy metabolism in healing colonic anastomosis was studied in rats. A one-layer, inverting colo-colostomy was performed and frozen sections from the anastomotic area were enzyme-histochemically stained for key enzymes in energy metabolism. Anaerobic metabolism prevailed in the anastomotic area during the first postoperative week. The repair tissue between the inverted colonic leaves showed the first sign of aerobic glycolysis 1 week postoperatively. Increasing lactate dehydrogenase activity, however, was seen from day 3 onwards (simultaneously with revascularization), and indicators for amino acid metabolism, lysosomal activity and metabolism via the pentose phosphate shunt were present even earlier--from day 1 onwards. Anastomotic surgery was followed by severe reduction of metabolism in all layers of the colonic wall 0-5 mm from the anastomotic line. Normal metabolism was not restored until postoperative day 21. These findings should be considered in surgical techniques and post-operative management.

Indomethacin has been reported to decrease pancreatic blood flow. The drug has been used as an analgesic in acute pancreatitis. As decreased blood flow to the pancreas may detrimentally affect the outcome of acute pancreatitis, we investigated the effects of indomethacin on blood flow in the normal porcine pancreas. Regional blood flows, with special reference to the pancreatic flow, were studied with radioactively labelled microspheres in ketamine-anesthetized pigs before and after intravenous administration of indomethacin 2 mg/kg during 10 min. A transient decrease of cardiac output was seen during the infusion. Basal pancreatic blood flow was significantly increased 10 and 30 min after administration of indomethacin. No significant changes were found in small-intestinal or renal blood flow. We conclude that indomethacin does not reduce blood flow in normal porcine pancreas.

Delayed 'blow-out' of retained thoracic oesophagus, 2 years after its exclusion for iatrogenic oesophageal perforation, gave rise to thoracic empyema. Oesophageal exclusion performed for benign, non-caustic conditions tends particularly to cause complications. Excision of the oesophageal remnant should therefore be considered in restoration of alimentary-tract continuity.

A 61-year-old woman was thought to have a cancer of the head of pancreas on ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography (ERCP). At laparotomy, however, the pancreas was normal, and the tumour originated in the inferior vena cava. Histological examination showed a moderately differentiated leiomyosarcoma. The outcome was uneventful after caval resection and reconstruction with a polytetrafluoroethylene (Goretex) patch.

In 79 patients undergoing hip or knee replacement surgery the preoperative condition of the popliteal vein valves was assessed by Doppler ultrasonography. Presence of postoperative deep vein thrombosis was determined by bilateral ascending phlebography seven to ten days after surgery. Antithrombotic prophylaxis consisted solely of TED stockings and early mobilization. The overall incidence of deep vein thrombosis was 20%. All thrombi were calf vein thrombi. One of these thrombi extended into the popliteal region and two into the femoral region. The incidence of deep vein thrombosis in patients with preoperative popliteal vein reflux when compared with patients with a normal popliteal valvular function was 55-15% (p less than 0.01). The incidence of deep vein thrombosis was also significantly lower in patients operated under epidural anaesthesia compared with patients under general anaesthesia. It is concluded that valvular incompetence of the popliteal vein predisposes to postoperative deep vein thrombosis.