Annales chirurgiae et gynaecologiae最新文献

Background and aims: To investigate the healing of sternotomies fixed with biodegradable self-reinforced poly-L-lactide (SR-PLLA) wire and comparing it with steel wire fixation.

Material and methods: Sixteen rabbits (15 Chinchilla and one New Zealand White rabbit) were operated on. Two parallel holes of 1.5 mm in diameter were drilled in the sternum at the level of the second and third rib and similar holes of 0.8 mm were drilled at the level of the third and fourth rib. A transverse sternotomy was created between both drill hole pairs. The sternotomy with larger drill holes was fixed with 1.1-mm thick SR-PLLA wire. The sternotomy between the smaller drill holes was fixed using 2.0 steel wire. The animals were sacrificed at 2, 7, 26 and 52 weeks postoperatively and specimens were taken, radiographed and studied by both light and scanning electron microscopy.

Results: One rabbit died at four months postoperatively as a result of gastrointestinal problems. No other complications were seen. The SR-PLLA wire was slowly degraded. There was no disturbance of bone healing. The implants were surrounded by a fibrous tissue capsule, which also contained chronic inflammatory cells. Both SR-PLLA and steel wires provided sufficient fixation security. No differences in the healing of the sternotomies were observed between SR-PLLA and steel wire fixation.

Conclusions: SR-PLLA wires are biocompatible and useful for sternotomy fixation. They may be suitable for use in clinical applications.

Background and aims: Ascending aortic atherosclerosis has been recognised as a potential source of atheroembolization during coronary artery bypass operation. A set of possible predictive preoperative factors for ascending aortic atheromatosis was studied to find the patients at greatest risk for aortic atheromatosis.

Material and methods: The records of 2,263 patients undergoing first-time coronary bypass operation from January 1993 to December 1995 were reviewed. Ascending aortic atheromatosis was considered to be present if the operating surgeon detected atheromatosis in ascending aorta by palpation or by sight while making aortotomies.

Results: Ascending aortic atheromatosis was found in 9.1% of the patients. Significant predictors in the multivariate model were age, tobacco use, diabetes, peripheral vascular disease, renal failure, chronic obstructive pulmonary disease, x-ray calcifications of the thoracic aorta and subclavian artery stenosis at minimum 50 %. The loose variety of atheromatosis was detected by sight while making aortotomies in 1.1% of patients. Significant predictors in the multivariate model for this loose variety were age, hyperlipidemia and renal failure. Patients with ascending aortic atheromas suffered significantly more perioperative myocardial infarcts and central neurological defects as well as succumbed more often.

Conclusion: This study defines some groups of coronary bypass patients that have increased risk for ascending aortic atheromatosis. Special attention should be paid to them during coronary bypass operation in order to minimise the otherwise increased risk for adverse neurological and cardial outcome.

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedematous and necrotizing pancreatitis. Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data. Persisting or progressive systemic or local organ complications occurring despite ICU-treatment are indicators for surgical management. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, surgical acute abdomen and persisting or progressing ileus should be treated surgically. The surgical technique is based on careful necrosectomy or debridement in combination with continuous or repeated surgical evacuation of necrotic tissue, bacteria and biologically active compounds. Necrosectomy and postoperative continuous local lavage resulted in a hospital mortality of 17% in necrotizing pancreatitis, conservative management of necrotizing pancreatitis in a hospital mortality of 6.3%. In 1442 patients treated in a 14-year period the overall hospital mortality was 4.4%.

Background and aims: In the surgical treatment of breast cancer, breast conservation is considered preferable to mastectomy provided that certain prerequisites are fulfilled. This retrospective analysis reports those factors which affected the choice between operations.

Material and methods: In 1993, a total of 104 women were operated on for breast cancer or carcinoma in situ in the Department of Surgery, University Central Hospital of Turku. There was a palpable tumour in 75%. In 23% the disease was found at mammography screening.

Results and conclusions: Breast conservation was achieved in 24%. The proportion was about the same whether the disease was found at screening or clinically (27% and 23%). In the presence of a palpable tumour breast conservation tended to succeed slightly more often than in wire-guided operations (26% versus 19%).

Treatment activity of vascular diseases varies depending on population, preference of doctors and the availability of vascular surgical services. Vascular registry offers an opportunity to review practice, to compare outcome with a standard, and to implement change to improve practice. Prospective data collection of all reconstructive vascular procedures has been performed in Finland for seven years. According to a review of the first five years, combined vascular and endovascular activity has increased nation-wide from 3508 procedures done in 1991 to 5200 in 1995. There are marked regional differences in the frequency and selection of various treatment modalities, which can not be explained only by epidemiological data but as well by skewed vascular care delivery. This data can be used for decision-making and should be used for planning of the vascular surgical services in Finland.