Biomedical subjects

H H Wasmuth

Publications and source records attributed to H H Wasmuth.

14 recordsLinked to original sources

PubMed2001

[Preoperative parathyroid scintigraphy in primary hyperparathyroidism].

BACKGROUND: The primary benefit of preoperative scintigraphy in patients with primary hyperparathyroidism not previously surgically explored seems to be the possibility of unilateral or limited access surgery in selected patients. MATERIAL AND METHODS: We studied the accuracy of scintigraphy using 99mTc sestamibi and dual phase imaging protocol combined with thyroid scintigraphy using 99mTc pertechnetate before conventional neck exploration and histologic verification in 78 consecutive patients. RESULTS: In 65 patients with solitary, focal uptake on scintigraphy, we found a solitary adenoma in 61 patients (94%), a solitary adenoma on the contralateral side in one patient, two adenomas on the indicated side in one patient, bilateral adenomas in one and hyperplasia in one patient. In 13 patients with a negative or equivocal scintigraphic result, eight had a solitary adenoma and five hyperplasia. INTERPRETATION: These result may support a limited unilateral surgical approach when scintigraphy shows a localized focal uptake and this is confirmed perioperatively. In experienced hands the risk of overlooking an adenoma will be small. However, it is mandatory to have an experienced parathyroid surgeon prepared to proceed with full neck exploration when this is necessary.

Adult↗

PubMed1998

[Cholecystectomy in the laparoscopic era].

Since 1991 laparoscopic cholecystectomy has been performed on 323 patients; 47 patients underwent conversion to open surgery. In the same period, 46 patients were primarily selected for open cholecystectomy. Half the patients were operated on because of gallbladder colic (the sole symptom). Conversion to open operation (14%) occurred not so much because of peroperative complications, but rather because of anatomical problems. On the fourth postoperative day, one patient died of septicaemia caused by iatrogenic diathermy damage to the duodenum. One patient developed a stricture of the choledochus as a result of ischemia. This was caused by dissecting the choledochus, having mistaken it for the ductus cysticus which was missing in this anatomic variant.

Adolescent↗

PubMed1997

[Laparoscopic sigmoidectomy].

The laparoscopic approach has emerged as an alternative to trephine stoma construction. In the present series, eight patients underwent laparoscopic faecal diversion. We performed two endsigmoidostomies and six sigmoid loop ostomies. Indications for diversion included inoperable obstructing pelvic carcinoma in three patients, perianal fistulas in another three--and faecal incontinence in one patient. A temporary loop-sigmoidostomy was performed in one patient after anal sphincteroplasty. Three or four ports were used. After mobilisation, the sigmoid colon was pulled through the abdominal wall. When an end-sigmoidostomy was performed the bowel was transected intra-abdominally. There were no operative complications and all stomas functioned early and well. Laparoscopic sigmoidostomy is safe and allows intra-abdominal exploration and mobilisation of the colon without the inconvenience of a mid-line surgical wound.

Adult↗

PubMed1997

[Stomach cancer. A 10-year material with emphasis on early cancer].

Between 1982 and 1991, 112 patients were treated for gastric cancer at Harstad Hospital in Northern Norway. Early gastric cancer accounted for 20% of all the adenocarcinomas (110), which is high compared with figures from other western studies. The role of endoscopy for detecting early gastric cancer is discussed. The five year survival rate after radical surgery was found to be significantly higher for patients with early gastric cancer than for patients who underwent curative surgery for either infiltrative or regional cancer. For patients with a tumour that had invaded the regional lymph nodes the five year survival rate was only 10%. This result can be improved by more extended lymph node dissection. The perioperative mortality rate (8%) was usually a result of severe cancer cachexia or underlying cardial disease, and not anastomotic leakage. The results as regards the cure of early gastric cancer are comparable with those described in other studies.

Adenocarcinoma↗

PubMed1995

The Harstad Injury Prevention Study: evaluation of hospital-based injury recording and community-based intervention for traffic injury prevention.

In a quasi-experimental study, hospital-treated traffic accident injuries were recorded prospectively for 7 1/2 years in the two Norwegian cities, Harstad and Trondheim. In Harstad the recorded data were used actively in analysis, planning, and implementation of a community-based injury prevention program. Trondheim was the nonequivalent control city. The intervention was divided into three periods, each of 30 months duration. Preventive efforts were implemented to some extent in period 1, increasingly in period 2 and period 3. Traffic safety was promoted in an extensive community program based on the Ottawa charter for health promotion. A 26.6% overall reduction of traffic injury rates was found in Harstad from period 1 to period 3 (p < 0.01), whereas a corresponding significant increase was found in the comparison city. Analysis of data from other sources were not conclusive in supporting the Trondheim data as showing the national trend. Alternative explanations for the injury rate reduction in Harstad were assessed by means of other available relevant data. The exact mechanisms that brought about the reduction of injury rates were hard to elucidate because so many intervention elements were implemented at the same time. It is concluded that at least some of the reduction was due to behavioural and structural changes brought about by health promotion. Important factors for the effect of and participation in the prevention program were local relevance and continuous feedback of accident injury data.

Accidents, Traffic↗

PubMed1993

[Calcitonin treatment of metabolic bone disease induced by parenteral nutrition].

After a near total small bowel resection for an acute thrombosis of the mesenterial artery, a 61 year-old man was treated with total parenteral nutrition at home for five years. The treatment was complicated by episodes of sepsis, anaemia and uremia. After four years he developed pain in long bones and the back and grave hypercalcuria. Roentgenogram showed demineralisation. There was no hyperparathyroidism and serum phosphate and serum calcium were normal. His chronic metabolic acidosis was treated continuously with enteral acetate. He received basal amounts of vitamin D and amino acids. By administering calcitonin we were able to cure his progressive bone pains and normalize his calcium urinary output. No side effects were observed. Therefore, calcitonin may contribute to the treatment of bone disease associated with total parenteral nutrition.

Bone Diseases, Metabolic↗

PubMed1992

[Surgical treatment of abdominal aortic aneurysms. Risk factors and complications].

Between January 1985 and April 1991 156 patients underwent surgery for abdominal aortic aneurysm at Nordland Regional Hospital. Of these, 90 underwent elective surgery; 36 were operated on for symptomatic aneurysm; 30 for ruptured aneurysm. The mortality rates were respectively 10%, 14% and 47%. Surgery for aortic aneurysm is on the increase. Advanced age, and associated serious cardiac disease predispose to postoperative complications and death. To reduce mortality better preoperative evaluation and treatment are essential.

Acute Kidney Injury↗

PubMed1992

[Abdominal aortic surgery. Transperitoneal or retroperitoneal approach?].

During the past five years a retroperitoneal approach was used in 34 patients and the transabdominal route in 49 patients for treatment of abdominal aortosclerosis. Both groups were identical with respect to age, sex and preoperative morbidity. In patients with previous laparotomy the retroperitoneal approach was always chosen. There was no significant difference with regard to postoperative complications. The only significant difference between the two groups after the operation was a trend towards earlier defecation among the patients treated by the retroperitoneal approach. We can not demonstrate any important advantage or disadvantage of the retroperitoneal approach. The transabdominal approach provides an opportunity to examine the abdominal organs for malignancy. We found one asymptomatic gastric cancer. The retroperitoneal approach is particularly suitable in patients who have undergone laparotomy before for expected severe abdominal adhesions.

Adult↗

PubMed1992

[Surgical treatment of aortic occlusion and obliterating aorto-iliac arteriosclerosis].

From 1985 to March 1991, 83 patients with the diagnosis aortoiliac obliteration and aortic occlusion were operated on at the Department of Surgery, Nordland Central Hospital. The main symptom was claudicatio intermittens. 16 patients had pain while at rest, and two had gangrene. The surgical technique was either Y-prosthesis or thrombendarterectomy. Four patients (4.8%) died postoperatively, three of myocardial infarction and one of intestinal ischemia and peritonitis. In our study 66 patients with aortoiliacal atherosclerosis were compared with 17 patients with aortic occlusion. Patients with aortoiliacal atherosclerosis demonstrated by angiography had much more severe infrainguinal arterial pathology. In the occlusion group the postoperative outcome, as measured by ankle/brachial index, was significantly better (p < 0.01). The study included four female patients less than 50 years of age with total infrarenal aortic occlusion. Their symptoms and signs are discussed.

Adult↗

PubMed1992

[Surgical treatment of acute intestinal ischemia. Successful treatment with embolectomy of the superior mesenteric artery].

We describe a patient with acute intestinal ischemia successfully treated with embolectomy of the superior mesenteric artery. Over the last four years, 11 patients with the same disease were treated with bowel resection at Nordland Regional Hospital. The mortality rate after bowel resection was 45%. Long duration of symptoms, and high frequency of associated cardiovascular disease was characteristic. In elderly patients with acute abdominal pain and cardiovascular disease, a diagnosis of acute mesenterial ischemia should be seriously considered. In patients with acute mesenteric ischemia and no bowel necrosis, embolectomy must be considered in preference to bowel resection.

Abdomen, Acute↗

PubMed1992

[Hip fractures in Troms and Oslo in 1989. Risk development 1978-89].

We studied the incidence of hip fractures in the county of Troms. This was compared with the incidence in a district of the city of Oslo. In both regions, the incidence increased almost exponentially with age both for men and for women. Since 1978, age-adjusted incidence has increased. This is most pronounced for men and for the county of Troms. In 1978 there was a marked difference between Oslo and Troms as regards risk of hip fracture. In 1989 this difference had diminished and persisted only among very old people. Risk factors other than postmenopausal and senile osteoporosis are discussed in an attempt to explain this development.

Aged↗

PubMed1991

[Early complications in treatment of femoral neck fractures. Experiences with Olmed screws].

Postoperative secondary displacement of displaced femoral neck fractures is a major problem in the treatment of this fracture. In a study of 232 femoral neck fractures operated at the Department of Surgery, Harstad Hospital and at the Departments of Surgery and Orthopaedics, Tromsø University Hospital, the reduction was lost in 12% of the displaced fractures within three months. The fractures were fixated with two 6 mm screws (Olmed). The deep infection rate was 3.4%. There were significant differences between the hospitals. The rate of redisplacement was 5% at Harstad Hospital and 29% at the Tromsø University Hospital (p less than 0.001), the rate of deep infection was 1.8% versus 7.5% (p less than 0.05). Early complications are caused by poor quality of reduction and incorrect positioning of the screws. The surgeons' lack of experience in treating these fractures gives rise to a high rate of complications. The main reason for the low rate of complications in the material from Harstad Hospital is continuous and prospective quality control of femoral neck fractures. Such continuous feedback, and an interest intreating these fractures among the surgical staff, obviously improves the results. When the Olmed method of fixation is used correctly the rate of early complications is small.

Adult↗

PubMed1990

[Bicycle injuries. Hospital based registration of injuries during 1985-89].

We analyze the results of 4 1/2 years of prospective registration of accidents to cyclists. 252 injured were treated at our hospital some as in-patients, some as out-patients. About 30% of all traffic injuries relate to cyclists. The true amount of these injuries is more than ten times the figure in the Norwegian official statistics. Most injuries occur in childhood and early adolescence, because these groups cycle most. Head injuries, wounds and fractures dominate. Two out of three of the injured are males. Accidents involving motor vehicles are more serious than other types of accidents and constitute about 17% of all injuries to cyclists. A lot of helmets have been sold, but no reduction in head injuries has been observed. The classical spoke injuries continue.

Accidents, Traffic↗

PubMed1989

[Injuries in nursing homes. Hospital-based registration of injuries of patients in nursing homes].

109 patients were registered in a prospective study of accidents occurring in geriatric nursing homes and treated in Harstad Hospital. In more than 50% the seriousness of the injury was so high that in-patient treatment was necessary. More than 90% of the patients had fallen and 50 patients had suffered fracture of the proximal femur. The incidence of injury is higher than the estimated 13% average, and the seriousness of the injury is substantially higher than the average for all age groups.

Accidental Falls↗