Annales chirurgiae et gynaecologiae最新文献

Aspirin and other NSAIDs are showing promise in the chemoprevention of colorectal cancer. Ongoing trials will eventually provide still lacking information about the optimum dose and treatment duration. NSAIDs may also help to lower the risk of cancer in other organs such as the oesophagus, and possibly breast, stomach, and lung. The chemoprevention by NSAIDs should be seen not as the sole method of prevention, but as an additional tool which will be accompanied by other approaches such as stopping smoking, limiting alcohol consumption, and eating more fruits and vegetables. The chemoprevention by NSAIDs needs also to be balanced against the risks of toxicity (particularly in the stomach) and the other beneficial effects such as prevention of cardiovascular morbidity and mortality. Some of the NSAID induced gastric ulceration and bleeding will most likely be avoided by adopting the use of cyclooxygenase-2 (COX-2) selective NSAIDs, which will selectively inhibit COX-2 while sparing COX-1.

Background and aims: The aim of this retrospective study was to compare the relative costs of treating simple and spiral wedge (requiring closed reduction under anaesthesia) tibial shaft fractures in a plaster cast or with intramedullary locking nail.

Material and methods: The material consisted of 26 fractures treated in a plaster cast and 51 fractures treated with an intramedullary locking nail. The costs caused by the direct costs (treatment, hospitalisation, and outpatient appointments) as well as indirect costs (lost productivity) were taken into account. Costs caused by complications were also included in the analysis.

Results: Mean direct costs per patient were FIM 22920 and FIM 26952 and mean overall costs per patient were FIM 120486 and FIM 82224 in plaster cast and intramedullary locking nailing groups, respectively (FIM 1 = USD 0.19). The higher mean overall costs of the plaster cast group were attributable to the longer sick leave periods in this group (218 days in plaster cast group and 124 in intramedullary nailing group).

Conclusion: Plaster cast treatment of simple and spiral wedge tibial shaft fractures requiring closed reduction under anaesthesia is more expensive to society than operative treatment with intramedullary locking nail.

Background and aims: To describe the clinical findings and surgical treatment of peroneus brevis split.

Material and methods: Two cases of longitudinal split of the peroneus brevis tendon are reported. One of the patients was a healthy middle-aged woman, who had fallen out of a car in a traffic accident and sprained her right ankle. Lateral ankle sprain was diagnosed and treated with a compression bandage. Lateral ankle pain persisted, however, with some swelling in the peroneal tendon region. MRI revealed a longitudinal partial rupture of the peroneus brevis tendon, which was treated surgically 12 months after the trauma. The second case was a 53-year-old woman, who had been suffering from rheumatoid arthritis for 2 years. Chronic pain and swelling in the peroneal tendon region were treated with 6 local corticosteroid injections without significant relief. Preoperative ultrasonography showed effusion of the peroneal tenosynovium, but the operation revealed a longitudinal split in the peroneus brevis tendon.

Results: In the first case, a single central peroneus brevis split was repaired with side-to-side suturation. After four weeks with a below-knee cast the patient was allowed to walk freely. At follow-up 12 months postoperatively, she was satisfied, although she still had some exertion pain in her ankle. In the second case, the torn fragment of the peroneus brevis tendon was excised and the ankle was mobilized early. Healing was complicated by a wound fistula, which was treated with antibiotics. Subluxation of the peroneus longus tendon necessitated a reoperation, which revealed a rerupture and a defect of the peroneus brevis tendon. The subluxation was repaired and the ruptured tendon ends were revised, followed by four weeks of below-knee cast immobilization, after which the patient was allowed to walk freely. The outcome was good.

Conclusion: Peroneus brevis split easily goes unrecognised or misdiagnosed. It must be considered in patients with a history of single or recurrent ankle sprain or a chronic inflammatory disease. Lateral ankle pain, diffuse or local swelling in the peroneal tendon region, and a stable or instable ankle with no peroneal weakness are the main symptoms and findings. MRI is the most exact method for diagnosing tendon split. Surgical treatment usually gives good results.

Background: Malignant oesophageal obstruction with an advanced disease presents a difficult challenge. A new class of metal stents have been developed to overcome the limitations of existing treatment modalities.

Methods: We present our first 58 patients, who have been treated with self-expandable metallic stents, using sedation anaesthesia, with fluoroscopic and endoscopic control. Both kinds of stents, covered and uncovered, were applied.

Results: There was no procedure-related mortality. The immediate relief of dysphagia was 98%. All four oesophageal fistulas were successfully sealed with covered stents. Due to stent migration, tumour overgrowth, or ingrowth, twelve (21%) of the patients needed re-intervention. Restenting or laser therapies were used against recurrent dysphagia.

Conclusion: The palliation of oesophageal malignant obstruction with metal stents is a rapid, effective, and relatively safe single treatment which can be employed as part of a multimodal treatment program.

Background and aims: It is not known, to what extent the observed cellular changes in healing surgical wounds are species-, individual- or site-specific or whether they depend on the research method used. The aim of this study was to compare two independent methods for harvesting wound cells from porcine wounds after two time intervals, and to assess individual changes of wound cell composition.

Material and methods: In a standardised wound model in six pigs, with eight dorsal skin incision wounds in each, the Cellstick device and the Wound Edge Contact (WEC) method were used to collect inflammatory cells from the same wounds at hour 6 or 24 post-surgery. The wound cells were stained by the May-Grünwald-Giemsa (MGG) -method and counted differentially.

Results: A significant difference was found between the 6 and 24 hour Cellstick specimen in the proportions of wound neutrophils (p = 0.007), lymphocytes (p = 0.02) and monocytes (p < 0.001). The differential counts of wound cells within each individual animal did not significantly differ from each other. Instead, a significant difference was found in the wound neutrophils (p = 0.001), lymphocytes (p = 0.04) and monocytes (p < 0.001) between the wounds of individual animals. The WEC method revealed the same significant differences in the wound cell proportions.

Conclusions: The Cellstick and the WEC method gave analogous results with equal variances from the incision wounds for up to at least 24 hours after injury.