Biomedical subjects
K Solheim
Publications and source records attributed to K Solheim.
[Liver injuries].
We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.
[Ambulatory surgery and incentives].
Day surgery is more cost-effective than in-patient surgical treatment and, for certain categories of patients is also a better quality form of care. It can often replace the traditional surgical treatment of patients, i.e. an operation with hospitalisation. For this reason, day surgery should become a more common form of treatment, also in Norway. This makes it necessary to create incentives that will encourage it. This cannot be done without first developing methods for collecting data on this activity.
[Changed injury pattern and by that therapeutic routines].
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[Air bags--do they help?].
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[Day surgery].
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[Hospitals misuse employments of trainee physicians].
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[A national registry for cholecystectomy. Quality assurance with practical consequences?].
Altogether 2,120 patients have been enrolled in the Norwegian Cholecystectomy Registry during the first 18 months after it was established. 1,699 patients (80%) were operated on laparoscopically. In 174 (10.2%) the operation was changed to an open procedure. 421 (20%) were operated on primarily using an open technique. The main quality problems were mortality (1.2%) and injuries of the common bile duct (0.95%) associated with open cholecystectomy. These frequencies are far above the values stated in available literature, and two interpretations are possible: Only the best results tend to be published internationally, and our results may be representative for the national average frequencies of serious complications in other countries too. On the other hand, the present results may disclose inadequate quality insufficiency and a need for improvement. The possible actions seem to be: Firstly, to try harder to avoid open cholecystectomy in seriously ill patients (ASA 3-4). If possible, they should not be operated on at all. When surgery is essential, a laparoscopic technique seems to cause less cardiopulmonary complications. Secondly, an improved dissection technique in open (and laparoscopic) surgery is necessary in order to reduce the frequency of injuries of the common bile duct.
[Attitude of the population towards autopsy].
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["Pouchitis" (inflammation of the ieal reservoir)].
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["Unnecessary laparotomy"].
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[Splenectomy--vaccination is necessary!].
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[Emergency call!].
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[Ethical dilemmas when teaching intubation techniques--what does the population think?].
Maintaining a clear airway and sufficient ventilation is vital in emergency medicine, but junior doctors and medical students rarely get sufficient training in the relevant techniques. These can be taught on mannequins, anaesthetised patients, or on recently deceased patients. The Norwegian and British medical associations recently banned the use of dead patients for intubation training for ethical reasons. A telephone survey of a random sample of 1,050 persons revealed that 69% would allow themselves to be practised on if they were anaesthetised, while 58% would accept that a close relative who had just died in hospital be used. Most of those who would not give their consent or who were unsure feared being injured, or the idea upset them. These results challenge previous assumptions about the attitude of the general public, and the medical associations' stand on the issue may have to be reconsidered for the sake of improving the teaching of vital skills.