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Biomedical subjects

J A Søreide

Publications and source records attributed to J A Søreide.

At least 19 recordsLinked to original sources
PubMed2006

Resuscitative emergency thoracotomy in a Scandinavian trauma hospital--is it justified?

OBJECTIVE: Resuscitative emergency thoracotomy (ET) is of value in selected (penetrating) trauma patients. Current survival-estimates and recommended guidelines are based on data from the United States. However, reports from European trauma centres are lacking. We report the current experience from a Scandinavian trauma hospital. METHODS: Identification of all consecutive ETs performed during a 5-year period. Data on demographics, and injury severity score (ISS), mechanism and location were recorded. Physiological status on admission (revised trauma score, RTS) and probability of survival (Ps) were calculated. Signs of life (SOL) and need for closed-chest cardiopulmonary resuscitation (CC-CPR) were recorded through the post-injury phase. RESULTS: Ten patients underwent ET with no survivors. The annual incidence of ET was 0.7 per 100,000 inhabitants during the study period, with an increasing trend during the last years (r=0.74, p=0.014). ETs were performed in 0.7% of all trauma admissions, and in 2.5% of all severely injured patients (ISS>or=16). Blunt mechanism dominated; only three had penetrating injuries. Most frequent location of major injury was "multiple" (n=4) and "thoracic" (n=4). The male to female ratio was 7:3. Median age was 51 years (range 21-77). Median ISS was 34.5 (range 26-75), indicating severely injured patients, with seriously deranged physiology (median RTS of 0.0, range 0-6.1) with poor chance of survival (median Ps of 4.4%, range 0-89.5%). Males had significantly lower RTS and Ps (p=0.007 and 0.03, respectively) than females. Eight patients had signs of life at some time post-injury, but only four in the emergency room. Six patients had both pre- and in-hospital CC-CPR. Four patients had additional surgery to ET. Two possible preventable deaths were identified (Ps) of 51 and 89%), one in a third trimester pregnancy. CONCLUSION: Emergency thoracotomy is a rarely performed procedure in a rather busy Scandinavian trauma hospital, and outcome is dismal. Reevaluation of our decision-making process concerning the use of emergency thoracotomy is needed. How survival data and clinical experience in Europe compare to current figures from North America deserves further attention.

Adult↗
PubMed2006

Pyloroplasty for benign gastric outlet obstruction--indications and techniques.

The understanding of peptic ulcer disease (PUD) etiology, and improvements in treatment during the last two decades, has dramatically decreased the once so frequently performed procedures for PUD and its complications. Benign gastric outlet obstruction may, however, still require operative intervention when non-operative treatment fails. Today, surgeons in training, and even practicing surgeons, may have limited operative experience with procedures required to alleviate an obstructed pylorus. Our aim of this paper is to review the techniques (the Heineke-Mikulicz and Finney pyloroplasties, and modifications) and indications for pyloroplasty in the modern surgical era.

Gastric Outlet Obstruction↗
PubMed2005

Ethics of palliative surgery in patients with cancer.

BACKGROUND: Surgery is an important palliative method for patients with advanced malignant disease. In addition to concerns related to clinical decision making, various moral challenges are encountered in palliative surgery. Some of these relate to the patients and their illness, others to the surgeons, their attitudes, skills and knowledge base. METHOD AND RESULTS: Pertinent moral challenges are addressed and analysed with respect to prevailing perspectives in normative ethics. The vulnerability of patients with non-curable cancer calls for moral awareness. Demands regarding sensibility and precaution in this clinical setting represent substantial challenges with regard to the 'duty to help', benevolence, respect of autonomy and proper patient information. Moreover, variations in definition of palliative surgery as well as limited scientific evidence with respect to efficacy, effectiveness and efficiency pose methodological and moral problems. Therefore, a definition of palliative surgery that addresses these issues is provided. CONCLUSION: Both surgical skill and much moral sensibility are required to improve palliative care in surgical oncology. This should be taken into account not only in clinical practice but also in education and research.

Beneficence↗
PubMed2004

Operable breast cancer patients with diagnostic delay--oncological and emotional characteristics.

AIMS: Delayed diagnosis in cancer patients often implies presentation with advanced disease with poorer prognosis as a consequence. The aim of the present study was to gain more insight into mechanisms which determine patient delay in the diagnosis of operable breast cancer, stages I and II. METHODS: Patient delay was related to socio-demographic, psychological and clinical-oncological variables in 96 consecutive patients investigated one day before surgery. RESULTS: Patients with a diagnostic delay for one month or more (N=29) reported increased emotional control compared to patients without delay (N=67) (Mean score on Courtauld Emotional Control scale (CEC) 54.5 vs 46.4; p=0.003) and more often grade I tumour (17 out of 29 vs 16 out of 67 patients; p=0.002). Diagnostic delay was predicted independently by tumour differentiation (hazard ratio=5.0; p<0.01 (95% CI: 1.7-14.8)) and emotional control (hazard ratio=5.1; p<0.01 (95% CI: 1.6-16.1)). Multivariate survival analysis with tumour grading and patient delay as covariates showed significant survival effect for tumour differentiation only (hazard ratio=4.4; p<0.05 (95% CI: 1.3-15.4)). CONCLUSION: There seems to be an association between aggressiveness of tumour growth, diagnostic delay and emotional control in patients with early stage breast cancer. Clinical implications of these findings are discussed.

Adaptation, Psychological↗
PubMed2001

[Cancer in addition....].

BACKGROUND: There is still controversy over the possible prognostic role of subjective and objective stress in patients with cancer. The present report is based on a six year follow-up study of a breast cancer patient cohort. We focus on the possible prognostic effects of behavioural variables recorded in an early phase of the disease, adjusting for known clinical prognostic factors. MATERIAL AND METHODS: 106 consecutive breast cancer patients stage I and II less than 71 years of age were investigated with interviews and questionnaires one day before and six weeks after surgery. Negative life events, impaired functioning and previous health parameters were recorded with standard questions. Coping style and emotional control were assessed with the Mental Adjustment to Cancer scale (MAC) and the Courtauld Emotional Control scale (CEC). RESULTS: At six years, 79 patients were still alive, including seven patients with relapse. Among 27 deceased patients, two patients died from other causes. There was a significantly increased risk (Hazard Ratio 2.6; 95% CI 1.18-5.77) of cancer specific deaths in women who "had suffered from one or more serious illnesses of more than six months' duration over the past 10 years" compared to those without previous illnesses. There were no significant results found for scores on the MAC or CEC scales. INTERPRETATION: Comorbid chronic diseases in cancer patients represent a negative prognostic factor with important clinical and health service implications.

Adaptation, Psychological↗
PubMed1998

[Invagination in children].

Although rare, childhood intussusception is one of the most common causes of small bowel obstruction in infancy. In these very young patients it can sometimes be difficult to interpret the clinical signs and symptoms correctly. This retrospective study comprises 79 children (median age 7.5 months; 24% girls and 76% boys) who experienced 83 episodes of intussusception. At admission the diagnosis made by the referring physicians could be confirmed in only about one-third of the cases. A barium enema was part of the inhospital diagnostic process. Non-operative treatment was attempted in 70 patients (89%), and barium enema reduction was successful in 64%. Laparotomy was required in 33 (42%) of the patients. No mortality, bowel perforation, or any other major complications were encountered. The diagnosis of childhood intussusception seems difficult to achieve in many cases, and the interpretation of, at times vague clinical signs and symptoms remains a challenge for all clinicians who are involved in the care of these very young patients.

Age Factors↗
PubMed1998

Posttraumatic distress symptoms in operable breast cancer III: status one year after surgery.

One hundred and six patients with operable breast cancer were studied at intervals one day before surgery, and at six weeks and one year post-operatively by means of taped clinical interviews and self-report questionnaires (Impact of Event Scale (IES) and General Health Questionnaire (GHQ-28)). A year after surgery, nine percent reported a high level of intrusive symptoms and 10% of avoidance symptoms compared to 18% and 14% after six weeks, respectively. Based on questionnaire data, a year after surgery, thirteen patients (12%) were estimated to have a posttraumatic stress disorder (PTSD) compared to fifteen patients (14%) after six weeks. Severity of posttraumatic stress symptoms (PTSS) after one year was significantly associated with impaired psychosocial functioning over the last year previous to surgery (p < 0.05), negative life events during the year before surgery (p < 0.05), health problems during the previous ten years (p < 0.01), and a personality trait characterized by high emotional reactivity (p < 0.001). Crisis support in the acute situation, type of surgery, axillary-node metastases, and postoperative adjuvant chemotherapy did not predict subsequent PTSS. Premorbid health variables, personality, and level of distress six weeks after surgery were most important risk factors for persistent PTSS in our patients with operable breast cancer stage I and II.

Adult↗
PubMed1997

Pre-operative [correction of Properative] psychological variables predict immunological status in patients with operable breast cancer.

UNLABELLED: In a prospective study of psychobiological responses in patients with operable breast cancer, psychological data were collected one day before surgery and immunological data one day before and seven days after surgery. OBJECTIVES: Explore psychoimmunological correlates related to primary surgical treatment of women with operable breast cancer. METHOD: Distress was assessed with Impact of Event Scale (IES), depression with Montgomery-Aasberg Depression Rating Scale (MADRS), coping with Mental Adjustment to Cancer (MAC) scale, emotional suppression with Courtauld Emotional Control scale (CECS) and neuroticism with EPQ-N. Number of lymphocytes and subsets of lymphocytes were analyzed using a flow-cytometric method. RESULTS: Intrusive anxiety and anxious preoccupation were statistically significant inversely correlated to number of lymphocytes, B, T total and T4 lymphocytes and depression to B and T4 lymphocytes using Bonferroni's correction for multiple testing. Multivariate analyses including menopausal status, type of surgery and health behaviour variables demonstrated an independent, inverse effect of depression on total number of lymphocytes, T total and T4 lymphocytes 7 days after surgery. Pre-post immune changes were influenced reversely by depression (decreased) and intrusion (increased). CONCLUSIONS: Psychological parameters have a statistically significant impact on the number of lymphocytes and subsets of lymphocytes.

Adaptation, Psychological↗
PubMed1997

Smoking and ulcer perforation.

BACKGROUND: The use of ulcerogenic drugs is the only well documented risk factor for peptic ulcer perforation, but accounts for only a quarter of the events. Smoking is a well known risk factor for uncomplicated ulcer disease, and patients with ulcer bleeding have increased death rates from smoking related disorders. AIM: To assess the role of smoking in ulcer perforation. SUBJECTS: A total of 168 consecutive patients with gastroduodenal ulcer perforation and 4469 control subjects from a population based health survey. METHODS: The association between ulcer perforation and smoking habits was analysed by logistic regression while adjusting for age and sex. RESULTS: Current smoking increased the risk for ulcer perforation 10-fold in the age group 15-74 years (OR 9.7, 95% CI 5.9 to 15.8) and there was a highly significant dose-response relationship (p < 0.001). The results were similar in men (OR 9.3, 95% CI 4.9 to 17) and women (OR 11.6, 95% CI 5.3 to 25), and for gastric (OR 10.5, 95% CI 4.5 to 25) and duodenal (OR 8.6, 95% CI 4.9 to 15.4) ulcer perforation. No increase in risk was found in previous smokers (OR 0.8, 95% CI 0.2 to 2.2). CONCLUSION: Our findings suggest that smoking is a causal factor for ulcer perforation and accounts for a major part of ulcer perforations in the population aged less than 75 years.

Adolescent↗
PubMed1996

Gastric emptying of a light hospital breakfast. A study using real time ultrasonography.

While intake of clear fluids 2-3 h before surgery is considered safe as it does not influence gastric content, it is not known if the same applies to a light breakfast meal. We therefore studied gastric emptying of a light breakfast in healthy, female volunteers without evidence of gastrointestinal motility disorders. The test meal consisted of one slice of buttered toast with jam, one cup of coffee without milk or sugar and one glass of pulp-free orange juice taken together with a paracetamol mixture. Using gastric ultrasonography, the stomach was identified without problems in all subjects, and gastric emptying curves using changes in gastric antral area and serum-paracetamol were obtained. Emptying of the fluid phase started immediately after intake of the meal. All subjects had solid particles in the stomach 120 min after the meal, 3 patients were considered empty after 180 min, 6 after 210 min and all after 240 min. The gastric antral area returned to fasting value significantly faster than the disappearance of solid particles; median 150 min versus 210 min; P = 0.01. Our results show that in healthy subjects the stomach cannot be considered empty for solid particles the first 4 h after a light breakfast meal. To secure some safety limits, we suggest a 6-h mandatory preoperative fast after a light breakfast.

Acetaminophen↗
PubMed1996

Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial.

OBJECTIVE: To find out the recurrence rate of chronic pilonidal sinus after excision and primary suture compared with open excision and healing by second intention. DESIGN: Randomised trial. SETTING: Teaching hospital, Norway. SUBJECTS: 120 Patients treated between 1987 and 1989. INTERVENTIONS: 60 Patients were treated by excision and primary suture and 60 by open excision. The median follow-up period was 4.2 years. RESULTS: Recurrent pilonidal sinus was seen in six patients (10%) after primary suture compared with three patients (5%) after open treatment (p = 0.49); 57 (95%) and 55 (92%), respectively, were satisfied with the outcome of treatment at follow-up (p = 0.72). CONCLUSION: Excision and primary suture compares favourably with open excision and healing by second intention in the treatment of chronic pilonidal sinus.

Adolescent↗
PubMed1995

[Surgical treatment of symptomatic pancreas divisum].

Pancreas divisum is found in 5% of the population. It is linked to three clinical entities; recurrent epigastric pain, and acute and chronic pancreatitis. The relation between chronic pancreatitis and pancreas divisum is, however, uncertain. Pancreas divisum is controversial as a cause of acute pancreatitis and abdominal pain. However, this association probably exists as surgical sphincteroplasty of the minor papilla alleviate symptoms in a high proportion of patients. We have treated two patients surgically. Patient 1 was hospitalized 11 times because of recurrent acute pancreatitis. Two and a half years after sphincteroplasty he has had no further attacks of abdominal pain. Patient 2 had had recurrent epigastric pain, mostly related to meals, since early childhood. Secretin stimulation initially showed normal pancreatic duct dilatation and emptying. After sphincteroplasty, and reoperation for stricture, she can eat normally without pain one year after the last operation. We conclude that in selected patients surgical treatment of symptomatic pancreas divisum is beneficial. Sphincteroplasty should be considered as treatment in patients with pancreas divisum and recurrent acute pancreatitis or pain, as long as other causes are excluded.

Abdominal Pain↗
PubMed1995

Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture.

Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.

Adolescent↗
PubMed1995

Patient characteristics and symptoms in chronic pilonidal sinus disease.

Three hundred and twenty two patients with pilonidal sinus disease were studied to determine factors for the development and maintenance of the disease. A calculated incidence of the disease of 26 per 100,000 inhabitants was found. It occurred 2.2 times more often in men than in women. Age at presentation was 21 years for men and 19 for women. Patients had two years (median) disease history before being referred for treatment. A family history could be found in 38% of the patients. 50% had normal body weight, and 37% were overweight. Local trauma or irritation preceded the condition in 34%, and a sedentary occupation was reported by 44%. Male sex, adolescence or youth, and a familial disposition seem to be associated with the development of pilonidal sinus. Local trauma and overweight are the most important conditioning factors for development of symptomatic pilonidal sinus disease.

Adolescent↗
PubMed1995

Adjuvant tamoxifen for pre- and postmenopausal women with estrogen receptor positive, node positive breast cancer: a randomized study.

370 patients with operable, axillary node positive breast cancer, were randomized to receive tamoxifen (TAM) 20 mg/day for 2 years or no adjuvant hormone therapy. All patients had estrogen receptor (ER) positive (ER > 10 pmol/g) primary tumours. 350 patients, 93 younger than 50 years of age and 257 patients 50 years or older, were evaluable for the study. After a median follow up of 76 months, significantly (p = 0.0001) fewer loco-regional, but not distant (systemic), relapses have been recorded in the TAM group. Overall survival was also improved, but even though the study was designed to give maximum benefit from TAM statistically significant effect of TAM seemed to be limited to patients 50 years of age and older.

Antineoplastic Agents, Hormonal↗