Biomedical subjects
Publications and source records attributed to E Trondsen.
Laparoscopy is fully recognized for diagnosis and even treatment of various acute abdominal conditions. In a 42-year-old woman with intense lower abdominal pain, laparoscopy revealed a perforated peptic ulcer. The ulcer was closed and patched with omentum and the abdomen was irrigated, all by laparoscopic techniques. Except for a minor wound infection recovery was uneventful.
Serum carcinoembryonic antigen (CEA) levels in relation to survival, flow cytometric DNA ploidy pattern, Dukes stage, and recurrent disease was prospectively evaluated in 406 patients with colorectal carcinoma. In 246 patients (61%) the carcinomas were DNA aneuploid. Increased preoperative CEA levels (> 5 micrograms/l) were found in 151 of 363 evaluable patients (42%). Dukes stage-B patients with preoperative CEA elevation showed significantly poorer prognosis than those with normal CEA values (p = 0.001). A weak but significant correlation was found between preoperative CEA level and Dukes stage (Kendall's tau = 0.25, p < 0.01). Of 50 evaluable patients with clinical recurrence and postoperative normal or normalized CEA levels, 28 (56%) had a rise in CEA before or at the time of clinical recurrence. The sensitivity of the CEA test for primary and for recurrent disease was not significantly different in the DNA aneuploid and the DNA near-diploid groups.
The authors describe the technique of endoscopic implantation of endoprosthesis in the bile duct. From 1978 to 1989 implantation of endoprosthesis was successful in 88.7% of 212 patients. One to three procedures per patient were required for primary implantation. 407 procedures were performed; primary implantation, replacement of endoprosthesis and implantation of additional endoprosthesis. The success rate increased from 55% in the first third of the period to 82.4% in the last third. Ten patients had been previously operated with Billroth II gastrectomy and one with Whipple's operation. Implantation was successful in seven of these patients.
212 patients were treated with endoscopic endoprosthetic drainage for bile duct obstruction. 137 patients had inoperable malignant obstruction, ten operable malignant tumor, 35 bile duct stones and 30 various benign strictures. Endoprosthetic stenting was successful in 188 patients (88.7%). The remaining 24 patients were treated with percutaneous transhepatic drainage or biliaryintestinal anastomosis, or received no treatment. In patients with successful implantation of endoprostheses, jaundice was relieved in 81% of the cases and pain in 89.6%. Cholangitis was treated with good results in 93.5%. Biliocutanous fistulas closed in two patients. Patency of the endoprostheses was 87 days on average. Replacement of endoprostheses or insertion of additional endoprostheses was performed 130 times. Complications occurred in 52 of 407 procedures (12.6%). Mortality related to the endoscopic endoprosthetic treatment was 4.2%.
Laparoscopic techniques have extended into the operative field of surgery. Appendectomies can be performed laparoscopically. The diagnosis of appendicitis is established and the inflamed organ removed directly. The laparoscopic technique reduces the incidence of unnecessary appendectomies and corresponding morbidity. Compared with conventional appendectomy, laparoscopy leads to less post-operative pain and inability to work. We discuss the first nine patients we treated in this way.
Techniques and instruments have recently been developed to perform laparoscopic cholecystectomy. Compared with conventional cholecystectomy, laparoscopic cholecystectomy results in significantly less post-operative pain and a shorter stay in hospital. We describe the procedure for laparoscopic cholecystectomy, with reference to the first patients treated in this way.
Endoprothetic stenting of the pancreatic duct is reported in limited series. Twelve patients are presented here. In five patients with confirmed or suspected pancreatic malignancy, pain and diarrhea subsided or disappeared, and two patients had a temporary gain in weight. Four patients with chronic pancreatitis all experienced relief of symptoms. One patient with a pancreatic abscess improved temporarily. A postoperative pancreatic fistula healed within two weeks. One patient with a stone in the pancreatic duct became temporarily free from pain. Two patients had minor complications. Efficiency of pancreatic drainage is difficult to evaluate. However, all our patients seemed to benefit from the treatment.
Surgical treatment of duodenal diverticula, although infrequently indicated, implies a high risk of postoperative complications. Diverticuloplasty was performed on five patients, four of whom had biliary or pancreatic duct obstruction and also underwent cholecystectomy and sphincteroplasty. The fifth patient had chronic abdominal pain. Complications occurred in three cases--postoperative diverticular bleeding, retroperitoneal hematoma and peroperative perforation of the common bile duct. The long-term results (3-10 years) were excellent in all cases.
In a 46-year-old woman endoscopic retrograde cholangiopancreatography, performed to evaluate acute pancreatitis, was followed by splenic rupture, probably due to manipulation of the patient on the X-ray table in combination with the endoscopic procedure. The excised spleen was histologically normal. Various causes of splenic rupture are discussed.
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