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Biomedical subjects

J Hildell

Publications and source records attributed to J Hildell.

At least 19 recordsLinked to original sources
PubMed1991

[Follow-up results of osteosynthesis of medial femoral neck fractures with the dynamic hip screw].

The operative treatment of subcapital femoral neck fractures of stages Garden III and IV in the young patient is still a problem. The current methods of osteosynthesis show a high rate of avascular necrosis of the femoral head. We controlled 24 patients with subcapital femoral neck fracture, who were treated with a dynamic hip screw (DHS). The average age of these patients is 55 years. They were examined after 30-89 months from the operation. All patients were assessed regarding clinical and radiological parameters. All of the six patients with femoral neck fractures of stages Garden I and II had no pain, their clinical results were good. In one of these patients we found a partial avascular necrosis of the femoral head. Four out of the 18 patients with femoral neck fractures of stages Garden III and IV had painful complications, 3 of them needed a reoperation. Fourteen patients of the group with femoral neck fractures of stages Garden III and IV had no pain and wer satisfied with the result. But in this group we found 7 patients with partial avascular necrosis of the femoral head. These results are discussed and compared with data published elsewhere.

Bone Screws↗
PubMed1990

[Roentgen studies of the small bowel].

Diseases of the small bowel are rare and this part of the gastrointestinal tract is the most difficult to explore radiologically. The examination results correlate directly with the indications. Whatever examination technique is used, it should be based on fluoroscopy. For most radiologists the combined single and double-contrast examination with air or methylcellulose is probably the most suitable. The interpretation should be done in a logical, stepwise way and with access to clinical information.

Crohn Disease↗
PubMed1986

Common bile duct obstruction due to an intraluminal mass of candidiasis in a previously healthy child.

A 3 6/12-year-old previously healthy girl had intermittent attacks of abdominal pain following a blunt abdominal trauma. At admission to the hospital, she had jaundice and hepatomegaly. Results of laboratory tests indicated an obstructive pattern, and ultrasonography revealed an intraluminal mass in the distal common bile duct. At surgery, the mass was confirmed as the cause of obstruction, and it was removed. Microscopic analysis indicated that the amorphous material was fungi infested. Growth cultures from bile and feces yielded Candida albicans. Postoperative treatment with T-tube drainage and antimycotic drugs led to an uneventful recovery. Clinical, biochemical, and ultrasonographic follow-up have shown no evidence of recurrence. A possible cause and effect relationship between the trauma and the development of biliary obstruction is suggested.

Abdominal Injuries↗
PubMed1985

Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features.

Five hundred and forty-seven middle-aged women, selected at random from the population of Malmö, Sweden, were invited to a screening survey for gallstone disease; 424 participated (77.5%). Forty-one had previously been operated on for gallbladder disease. The prevalence of gallstone disease, on the basis of a positive finding at ultrasonography and cholecystography, was 11%. The predictive value of a positive finding at ultrasonography was 86%. Six out of 10 women with gallstone were classified as asymptomatic. Body weight, blood pressure, liver enzymes, fasting blood glucose, and blood lipids, including apolipoprotein-A, did not differ significantly in women with and without gallstone disease. At least 9 out of 10 gallstones appeared to be cholesterol stones. Approximately half were of a size that would make them accessible for dissolution therapy.

Cholecystography↗
PubMed1984

Ultrasonography in complications of renal transplantation.

The reliability of ultrasonography in detecting complications of renal transplantation was investigated by reviewing the ultrasound examination on 78 renal transplants. The results of the ultrasound examinations were correlated with all available clinical, laboratory, radiographic, scintigraphic, and histopathologic data. With the exception of one urine leak no extrarenal complications of clinical significance, such as hydronephrosis, urine leak, lymphocele or hematoma were overlooked at ultrasonography. The exact nature of fluid collections was, however, only seldom accurately assessed unless fine needle biopsy was used. The accuracy in detecting both acute and chronic rejection was high with ultrasonography and a normal ultrasonography of a non-functioning kidney was a strong indication of acute tubular necrosis. Ultrasonography was very sensitive in detecting early acute rejection but was of less value in diagnosing repeated acute rejections with short intervals and in monitoring the response of treatment as the sonographic changes of rejection disappeared slowly.

Acute Kidney Injury↗
PubMed1984

Pre- and post-operative complications in Crohn's disease with special reference to duration of preoperative disease history.

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohn's disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohn's disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohn's disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.

Crohn Disease↗
PubMed1983

Recurrence rate after surgical treatment of Crohn's disease.

In an unselected series of 207 consecutive patients with Crohn's disease diagnosed between 1958 and 1974, 170 underwent a resection of all the macroscopically involved bowel ('radically' resected). Two patients died during the first postoperative month. The crude recurrence rate for the surviving 168 patients was 49%. The cumulative recurrence rate, calculated by the actuarial method, was 53% at 15 years. Age, sex, length of preoperative disease history, localization of the lesions in the bowel, and primary surgical procedures performed had no influence on the recurrence rate. However, the histopathological appearance of the resection margins seemed to influence the prognosis, since the presence of ulcers and/or granulomas was correlated with a significantly increased recurrence rate.

Actuarial Analysis↗
PubMed1983

Crohn's disease in a defined population course and results of surgical treatment. I. Small bowel disease.

In a total, unselected series of 207 patients with Crohn's disease diagnosed between 1958 and 1974, 87 of the 182 patients operated upon during the investigated period were, at a comprehensive reevaluation, found to have the disease predominantly or exclusively confined to the small bowel. In five of these cases wide-spread lesions were present. The frequency of preoperative sequelae or complications was low. Postoperative complications were comparatively few with only one death. The calculated recurrence rate at 15 years was 43%. In spite of the fact that some patients needed repeated resections, the outcome of surgery as assessed at the end of the observation time was good in most cases.

Adolescent↗
PubMed1983

Crohn's disease in a defined population course and results of surgical treatment. Part II. Large bowel disease.

In a total consecutive series of 182 patients operated upon for Crohn's disease, 95 (52%) had the lesions predominantly or exclusively confined to the colon. A "radical" operation was performed in 88 of these 95 patients. The general policy was to spare the rectum, if possible. It was found that when the rectum was primarily involved the lesions did not disappear after subtotal colectomy. Ileorectal anastomosis was only successful in 9 of 22 cases. In all these nine cases the rectum was uninvolved preoperatively. The overall mortality rate related to Crohn's disease was 6% and the overall recurrence rate 62%. All patients with an anastomosis between a disease-free small intestine and a diseased colon developed recurrence in the ileum. Therefore, a thorough preoperative examination of the whole colon is essential.

Adolescent↗
PubMed1982

Computed tomography in the diagnosis of complications following renal allograft surgery.

Computed tomography was used in a consecutive series of 74 transplantations in the diagnosis of complications to renal allograft surgery. Thirty-nine peritransplant fluid collections were demonstrated, 13 of these were subjected to surgery. A diagnosis of the specific nature of the fluid collection was possible in cases of urine leakage and fresh hematomas. The method was sensitive in defining the size of the renal pelvis though differentiation between postrenal obstruction and large non-obstructed collecting system was not always possible. The cause of postrenal obstruction could be identified in 5 patients out of 10. Renal infarctions were diagnosed in 8 patients. Computed tomography seems to be a highly accurate method in the diagnosis of complications to renal allograft surgery. The method can be used independent of transplant function and the use of contrast medium is necessary only to verify urine leakage and infarction.

Adolescent↗
PubMed1981

[Functional control of the renal transplant via sequential computerized tomography. First results (author's transl)].

The enhancement of cortex medulla and arteria iliaca can be visualized separately, evaluated densitometrically and represented graphically by means of sequential computerized tomography of the renal transplant following intravenous contrast medium bolus injection. Since this enhancement performance is mainly dependent on perfusion, it is possible to determine the perfusion value of individual measurement areas. For example, a cortical defective perfusion, as is known in rejection, becomes evident as a flattening-out of the initial rise of cortex enhancement and can be distinguished from the largely normal type of curve obtained in acute tubular necrosis (ATN). The angiographically known prolonged "wash-out time' in rejection corresponds to a long-lasting corticomedullary density gradient. Despite restricted informative value because of the relatively small number of patients, it appears that sequential computerized tomography enables differentiation of postoperative anuria.

Adult↗
PubMed1981

[The diagnosis of renal perfusion abnormalities by sequential CT (author's transl)].

Abnormalities of renal perfusion can be recognised more readily by sequential CT than by a plain CT scan or after "static" enhancement with contrast medium. Haemodynamically significant stenoses of the renal arteries and total, or partial, infarct can be diagnosed in this way. Intrarenal and capsular collaterals can be recognised by slow contrast accumulation in the infarcted area, or by the development of contrast in the sub-capsular portion of the cortex. Renal cortical necrosis is very well demonstrated by the absence of cortical perfusion; this is seen, for instance, in the DIC syndrome or during rejection after renal transplant.

Disseminated Intravascular Coagulation↗