Biomedical subjects
Publications and source records attributed to A Tilma.
A 36 year-old woman with first degree splenic rupture from blunt abdominal trauma underwent laparotomy due to haemodynamic instability. The spleen was enlarged and difficult to mobilize with the rupture on the upper-lateral face of the spleen. Classic splenorrhaphy could not be performed. A single-clip-stapler made for laparoscopic herniotomy was used successfully to close the lesion.
The technique by which percutaneous access to the stomach for enteral nutrition is obtained is generally accepted in cases in which swallowing is defective and for aspiration in cases of gastro-intestinal retention. Experience with a gastrostomy tube developed in Denmark has provided inspiration to establish access by means of outpatient intervention. Since 1986, 15 patients with defective swallowing were treated as outpatients with percutaneous introduction of a gastrostomy tube without complications of the intervention or to subsequent management in nursing homes or their own homes. Replacement of the catheter was undertaken by the general practitioner or by renewed outpatient visits. In many of the patients, replacement of the catheter was performed by the caring staff. A narrow-bore tube was chosen primarily in order to reduce the risk of complications. Despite the narrow-bore tube, the effect of the decompression tube has proved satisfactory in five patients since 1986. The method is simple, the trauma minimal and it is well accepted by the patients.
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From 1968 to 1978, 37 men and 14 women, with a median age of 43 years, were operated on for a pancreatic pseudocyst. Alcohol abuse was the dominating cause in 65% of the patients. Internal drainage (medium risk patients) was carried out in 76%, external drainage (high risk patients) in 12%, and pancreatic resection (low risk patients) in 12% of the patients. The hospital mortality rate was 14%. The patients who died were significantly older than those discharged from the hospital alive. At the time of follow-up (1--11 years, median: 4 years) after operation, a further 13% had died. Thirty per cent of the alcoholic and none of the nonalcoholic patients had severe pain at follow-up examination. Evaluated by their ability to work and pain, the late results were poorer for the alcoholics who continued drinking, better for alcoholics who had stopped drinking and best for nonalcoholics.
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Pyomyositis was studied in 25 patients over a period of 1 year. The patients lived in a subtropical region, latitude about 27 degrees S, but the disease described is the same as that which occurs in the tropics and which goes by the name of "tropical myositis". The aetiology proposed for tropical myositis is regarded as not applicable to the same disease described here, of which the cause remains uncertain. This aspect of the problem is discussed with reference to the possible role played by a deficiency of ascorbic acid in the diet. Incision and drainage is the only method of treatment.
The study is a comparison of Dexon (polyglycolic acid) and Mersilene (polyester) sutures when employed for the primary closure of the peritoneum and aponeurotic layer in primary laparotomy incisions. The material comprises 308 closures of abdominal wounds with interrupted 2-0 sutures (United States Pharmacopeia) in the aponeurosis and continuous 2-0 suture of the peritoneum. One half of the wound was closed with Dexon and the other half with Mersilene, so that the patient acted as his own control. No significant difference was found between the two materials as evaluated from the occurrence of wound rupture within 10 days and incisional hernia within 90 days of the operation. Suture granulomas occurred in 9% of the half wounds sutured with Mersilene. The present clinical investigation demonstrates that Dexon sutures are as reliable as unabsorbable material. Dexon is superior to unabsorbable material as suture granulomas were not seen when Dexon was employed.
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