[Reconstructive vascular surgery in the aged. The postoperation social status of patients over 70].
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Biomedical subjects
Publications and source records attributed to F Moesgaard.
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Wound infection, defined as accumulation of pus draining spontaneously or after opening of the wound, developed in 19 out of 22 guinea pigs (86%) after intraincisional contamination with 10(7) Escherichia coli plus 10(8) Bacteroides fragilis before wound closure. Antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 86% to 29% (p less than 0,001). Pus for bacteriological studies was available in all cases of wound infection but one, and culture always revealed both Escherichia coli and Bacteroides fragilis. The animal model presented employs widely accepted criteria for wound infection, and avoids culture of tissue homogenates.
Forty consecutive patients who developed subcutaneous abscesses after intraperitoneal operations were treated by incision and drainage followed by suture of the wound four days later under antibiotic cover. The wound was closed by means of interrupted Prolene sutures. No sutures were placed in the wound cavity, and no drain was applied. The antibiotic used was clindamycin 600 mg intravenously peroperatively and 150 mg every six hours for four days.
During a 5-year interval 72 consecutive patients with urethral strictures were treated by internal urethrotomy according to the method of Otis. The etiology, surgical technique, complications and postoperative management are discussed. The results after a mean followup of 29 months showed an over-all success rate of 82 per cent (95 per cent confidence limits 71 to 90 per cent). It is concluded that internal urethrotomy should be considered for primary treatment of urethral strictures, since the procedure is easy and complications are few.
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Six duodenal ulcer patients were investigated before and 3 months after truncal vagotomy and pyloroplasty. Plasma concentrations of gastric inhibitory polypeptide (GIP), insulin, and glucose were measured during intrajejunal infusion of 50 g of glucose. The GIP response was significantly diminished postoperatively; insulin and glucose concentrations, however, were unchanged. The reduction of GIP release was positively correlated with the reduction of the peak acid output. The results suggest that a reduced vagal innervation of the intestine is accompanied by reduced GIP release after intrajejunal glucose, depending on the degree of completeness of vagotomy.
Forty-nine patients more than 70 years of age had a follow-up examination two to eight years after choledochoduodenostomy for common duct stones or for common duct strictures following a previous biliary tract operation. Death followed operation in two patients and was not related to the choledochoduodenostomy itself. Results of the follow-up examination revealed that none of the patients had had signs or symptoms of cholangitis, jaundice or episodes of fever. One patient only had recurrent, but mild, biliary colic. Choledochoduodenostomy is well tolerated in old age and justified in elderly patients with multiple stones in dilated common ducts as a precaution against retained or recurrent common duct stones.
A conventional barium enema of the colon was performed in 300 patients with haemorrhoids referred to a surgical department. No malignancies were detected by X-ray, while one cancer of the rectum was revealed by sigmoidoscopy. It is concluded that barium enema should not be used as a routine but only in patients with symptoms which cannot be explained by haemorrhoids.
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A case with severe diarrhoea and Strongyloides stercoralis infection is described. Further examination showed that the patient also had abnormal colonization of the duodenum with Hafnia alvei and that this disappeared when the Strongyloides infection was treated with mebendazole. Symptoms such as abdominal pain, diarrhoea, "skin rash" and malabsorption in association with blood eosinophilia should arouse suspicion of strongyloidiasis.