[Prognosis in untreated abdominal aortic aneurysm is almost as bad today as 20-30 years ago].
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Biomedical subjects
H Truedson
Publications and source records attributed to H Truedson.
Renal angiomyolipoma presenting as a rupturing abdominal aortic aneurysm.
A case of renal angiomyolipoma with massive retroperitoneal hemorrhage, presenting as a rupturing abdominal aortic aneurysm, is reported. A lesion in the caval wall lead to a fatal outcome. Clinical, diagnostic and therapeutical aspects are discussed.
Aorta, Abdominal↗
A new method of stomal reconstruction in patients with retraction of conventional ileostomy.
A new method of stomal reconstruction has been evaluated in three patients with retraction of a conventional ileostomy associated with special problems. A polyglactin 910 mesh has been used for remodeling of the ileostomy. The observation times vary from 20 to 37 months. There has been no recurrence of retraction in any of the patients during this period.
Follow-Up Studies↗
Scalene lymph node biopsy. A diagnostic method in sarcoidosis.
Right-sided scalene lymph node biopsy was performed on 167 patients with sarcoidosis. The surgical technique is described in detail. There were no complications, apart from two cases of minor postoperative haemorrhage. The diagnostic yield in sarcoidosis was 84% (140/167 patients). Scalene lymph node biopsy, performed by trained surgeons, is concluded to be a good alternative to other biopsy methods in sarcoidosis.
Adult↗
Reconstructive vascular surgery in diabetic patients with peripheral arterial insufficiency.
Peripheral arterial insufficiency in diabetic patients is for vascular surgeons a special problem as there even may be a distal diabetic angiopathy in the leg arteries. Preoperative adequate evaluation and selection of the patients is necessary before vascular reconstruction. Of 100 consecutive patients operated on with femoropopliteal bypass 33 were diabetic and 67 nondiabetic. Eleven of the diabetic patients were one year later asymptomatic, eight improved but eight were amputated.
Adult↗
Arteriovenous shunt in the management of severe asthma.
Arteriovenous shunt is described as a possible method to achieve vascular access in selected chronically ill patients with poor peripheral veins and, in the case of acute exacerbation, a prompt demand for access to the venous blood flow. Three patients with severe bronchial asthma are described, in whom arteriovenous shunts have been of great value.
Adult↗
Elective cholecystectomy with intraperitoneal drain. A bacteriological evaluation.
The occurrence of bacteria in 108 patients operated on with elective cholecystectomy was investigated in specimens from preoperative skin, gallbladder bile, drain wound secretion and drainage fluid. Growth of bacteria in gallbladder bile was found in 13% and in drainage fluid in 46% of the patients. The occurrence of bacteria in drainage fluid was not correlated with the operative time or the experience of the surgeon. The presence of pathogenic bacteria in the drainage fluid in our investigation was related to increased amounts of drainage fluid and to increased incidence of infectious complications (manifest or suspected intra-abdominal abscess and wound infection). Growth of bacteria analogous to those found in drainage fluid was observed in gallbladder bile (5% of the patients), in preoperative skin culture (12%) and in drain wound secretion (14%). Most of the bacteria in the drainage fluid seemed to come from an exogenic source. However, in 35% of the patients with bacteria in the gallbladder bile analogous bacteria were demonstrated in the drainage fluid. Since an increased occurrence of bacteria in gallbladder bile has been found in patients with acute cholecystitis and in patients more than 60 years of age the use of intraperitoneal drain from a bacteriological point of view could thus be limited to these groups of patients.
Bacteria↗
The incidence of bacteria in gallbladder bile at acute and elective cholecystectomy.
Aerobic and anaerobic bacterial cultivation was carried out on gallbladder bile collected from all patients operated on with cholecystectomy during a 10-month period. Acute cholecystectomy was performed on 34 patients because of acute cholecystitis. Elective cholecystectomy was performed on 177 patients because of non-acute gallbladder pathology. Bacteria were found in gallbladder bile in 16.4% of patients with non-acute cholecystopathy compared to 58.8% of patients with acute cholecystitis (p less than 0.001). An increased incidence of pathogenic bacteria was observed in the acute compared to the elective cholecystectomy material. The acute inflammatory process, its severity and the age of the patient seemed to be important factors which could be related to the increased occurrence of bacteria in the gallbladder bile. A higher incidence of postoperative morbidity and infectious complications was found in patients with pathogenic bacteria in gallbladder bile than in patients with no growth of bacteria or opportunistic bacteria in gallbladder bile.
Acute Disease↗
Cholecystectomy with and without intraperitoneal drain.
383 patients undergoing cholecystectomy for non-acute gallbladder pathology were randomized with regard to the use of an intraperitoneal drain. 187 patients were drained, 196 patients were not drained. The postoperative course of temperature and liver laboratory tests, the duration of hospital stay and the postoperative morbidity were studied. There were no obviously significant differences between drained and undrained patients. Thus drainage of the subhepatic space after cholecystectomy as performed in this study, could not be associated with any disadvantages for the patient. The advantage of the intraperitoneal drain, could, because of a failing randomization in 13% of the patients not be completely evaluated. The preventive effect of the drain with regard to the incidence of postoperative complications however appeared to be very limited. The use of a prophylactic intraperitoneal drain after cholecystectomy could therefore safely be limited to appropriate patients as judged by the operating surgeon.
Body Temperature↗
Postoperative pulmonary ventilation after cholecystectomy with and without peritoneal drain.
Postoperative lung function, chest X-ray and diaphragmatic movements were measured in 38 patients operated on with elective cholecystectomy with and without drain. 21 patients were drained and 17 were not drained. The results showed that there was a marked decrease of vital capacity (VC), peak expiratory flow (PEF) and diaphragmatic movements postoperatively in all patients. There was no statistically significant difference between patients with and without intraperitoneal drain. Postoperative chest X-ray changes were found in seven patients with drain and in two patients without drain. Patients with postoperative chest X-ray changes showed a much slower recovery of the measured variables. The difference in VC and PEF between patients with and without postoperative pulmonary complications was statistically significant from the third day postoperatively. It is postulated that pre- and postoperative monitoring of simple lung function tests can be helpful in early detection of postoperative pulmonary complications.
Adult↗
Cholecystectomy with intraperitoneal drain.
The effects of prophylactic intraperitoneal drainage after cholecystectomy were studied in 389 patients operated upon with elective and in 68 patients operated upon with acute cholecystectomy. The drainage fluid and the duration of drainage were measured and related to clinical variables and postoperative morbidity. The amount of drainage fluid varied from 0 to 1075 ml after elective cholecystectomy and from 5 to 4500 ml after acute cholecystectomy, but there was no statistically significant difference between electively and acutely operated patients. Increased amounts of drainage fluid were significantly more often found in patients with not dry operative field at the end of the operation compared to patients with dry operative field. The maximum daily discharge of drainage fluid occurred during the first and second postoperative day in most patients. The incidence of postoperative morbidity was significantly higher in patients operated upon with acute cholecystectomy. After elective cholecystectomy the postoperative morbidity was significantly increased in patients who drained greater than 150 ml of fluid and also in patients who were drained for three days or more. Relaparotomies because of intraperitoneal hemorrhage and bile leakage or abscess were in spite of intraperitoneal drain performed in six patients after elective cholecystectomy and in one patient after acute cholecystectomy.
Adolescent↗
Cholecystectomy with intraperitoneal drain. Presence and significance of conjugated bilirubin in the drainage fluid.
The content of conjugated bilirubin in the drainage fluid of 85 patients, operated upon consecutively with cholecystectomy and intraperitoneal drain for nonacute gallbladder pathology was measured by the adapted method of Jendrassik and Grof. The measured amounts varied from 0 to 755 micromol. A weak correlation was found between the concentration of conjugated bilirubin and the total amount of drainage fluid (r = 0.37). In the majority of patients the evacuated amounts of conjugated bilirubin corresponded to the content of bilirubin in a few milliliters of hepatic bile. In 10% of the patients there were however greater amounts of conjugated bilirubin in the drainage fluid. Greater amounts of conjugated bilirubin were significantly more often evacuated from patients operated upon by surgeons with less than 3 years of surgical experience compared to patients operated upon by more experienced surgeons. The amount of conjugated bilirubin in the drainage fluid was not significantly correlated with operative blood loss, dryness of the operative field at the end of the operation or iatrogenic perforation of the gallbladder during operation. Higher (however not significant) temperatures and bilirubin levels in serum were observed in patients with greater amounts of conjugated bilirubin in the drainage fluid. Increased amounts of conjugated bilirubin in the drainage fluid were not significantly associated with increased postoperative morbidity. Two of the patients with large amounts of conjugated bilirubin in the drainage fluid were reoperated because of bile leakage/abscess but the remaining patients had no serious complication, which could be a result of efficiency of the intraperitoneal drain.
Adult↗
Scalene node biopsy in sarcoidosis.
Scalene node biopsy was performed by a trained surgeon in 39 patients with established sarcoidosis. The diagnostic yield in this group was compared wtih the results in 43 patients with established sarcoidosis who had been subjected to routine scalene node biopsies at the same clinic. Sarcoid tissue was found in 82% of the patients operated on by the trained surgeon compared with 47% in the other group. It is concluded that, in the hand of a trained surgeon with a good operating technique. scalene node biopsy is a good alternative for obtaining tissue from sarcoidosis patients for histopathological examination.
Adult↗
Leakage from T tube tracts as determined by contrast radiology.
The continuity of the T tube tract on removal of the drain was studied by fluoroscopic examination in 51 patients. Leakage was found in 25 cases (abdominal cavity 7, wound drain 6, local cavity 11, combined abdominal and wound drain leakage 1). No correlation was found between the incidence of pyrexia or pain and the presence of leakage. These complications, noted in 10 patients, are probably explained by bacterial contamination of the bile in combination with the trauma caused by extraction of the tube.
Adult↗
Intraperitoneal drain in cholelithiasis operations.
571 patients were operated on for cholelithiasis, 70 acute cases and 501 chronic ones. On 142 cases of the latter type choledochus exploration was performed, while on the others only simple cholecystectomy was carried out. Intraperitoneal drain in the form of a latex tube was used on all the acute cases except 4, on all who underwent choledochus exploration except 3, and on 254 of the 359 chronic cases on whom simple cholecystectomy was performed. The analysi of the material shows that the indications for intraperitoneal drainage are not very convincing after cholecystectomy at a chronic stage, considering the amount of fluid drawn via the intraperitoneal drain and the complications that arose. After choledochus exploration, however, intraperitoneal drain serves its purpose in connection with the removal of the choledochus drain. Intraperitoneal drain should therefore be used when choledochus has been explored. In routine cases it should not be removed until the choledochus drain has been withdrawn.
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