Biomedical subjects
Publications and source records attributed to E Waever.
Four cases of muscle-aponeurotic fibroadenomatosis (desmoid) of the abdominal wall are reported. The etiological factors, the recurrence rate, the treatment and the pre- and postoperative examinations are discussed.
The Conseal plug was evaluated in a four week period among 30 consecutive colostomy patients. The clinical trial, a multicenter study covering 11 Danish Hospitals, was started five to 12 days postoperatively among motivated patients in good physical condition. Twenty patients (67%) completed the trial. Ten patients (33%) gave up because of wound infection, leakage, extrusion of the foam part or fault in the test procedure. At the end of the trial all 20 patients wanted to continue using the plug and 84% were still using the Conseal system six months later. We conclude that the plug is well tolerated among motivated patients less than a week postoperatively and that the Conseal plug is a good alternative to the colostomy bag early in the postoperative course.
On account of improved management in neonatal intensive care units, the survival rate is presently nearly 50% in babies with birth weights below 1,000 grams and 80% in the group with birth weights from 1,000 to 1,500 grams. A number of these babies require surgery, either for correction of congenital anomalies or for acquired necrotizing enterocolitis, which is an increasing burden in neonatal units. The present analysis of 24 babies weighing under 1,500 grams, operated on in the period 1981 to 1988 confirms that even extremely small babies tolerate the performed anesthesia and surgery well. In the group with anomalies (7 of 24) three died (43%). The causes of death do not appear to be related to the anesthesia or surgery. In the group with necrotizing enterocolitis (15 of 24) six died (40%). The cause of death was directly related to the septic condition in all cases, and the surgical trauma does not appear to have any negative influence. Unfavourable prognostic factors in this group were low Apgar scores within the first minute and preoperative weight loss.
Young-Dees' method of bladder neck reconstruction is described. A material of 17 cases with complete or almost complete incontinence on account on a deficient sphincter who were submitted to this operative method is presented. It is concluded that the method can be recommended as the primary operation for incontinence, particularly in patients with exstrophy of the bladder or epispadias as satisfactory continence could be obtained in 60%. No deterioration of renal function was observed and the patients functioned well both socially and sexually.
During the decade from 1976 to 1986, the age-related incidence of meconium ileus equivalent (MIE) was calculated on the basis of 240 Danish cystic fibrosis (CF) patients. In the first 5 years, the patients were given enteric-coated granules of pancreatic enzymes (Pancreatin, Rosco, Denmark), and a low fat diet was recommended. In the last 5 years, the Center recommended supplementation with acid-resistant, enteric-coated, encapsulated microspheres (Pancrease, Cilag, Birkerød, Denmark), and high-energy intake with a 40% fat content and no dietary restrictions. There was no difference in the incidence of MIE when these two 5-year periods were compared, and the overall incidence of MIE was low (5.4 MIEs/1,000 patient years). This may, at least in part, be due to the rather high intake of exocrine pancreas enzyme supplementation (EPES) (a mean intake of 0.9 capsules/kg/day). MIE occurred almost exclusively among patients greater than 15 years old and peaked in young adults aged 20-25 years (35.5 MIEs/1,000 patient years). The daily intake of EPES/kg of body weight declined significantly with age, and the patients who developed MIE received even less than average per day. Both of these points strengthen the view that a low enzyme dosage is likely to have an effect on the incidence of MIE.
Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%. Pathophysiologically, MIE is probably caused by a combination of EPI, increased intestinal transit time, and abnormal intestinal mucus. The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.