[Liver resection for metastatic tumor].
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Biomedical subjects
Publications and source records attributed to K Solheim.
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One hundred and forty-seven patients with splenic injury were entered in a prospective multicentre study including 18 hospitals. The diagnosis was made by scintigraphy in 55 patients, ultrasonography in 51 and computed axial tomography in 31. Exploratory laparotomy was performed in 52 patients, in 23 of these after a positive peritoneal lavage. Splenic injury was found in 33 per cent of the ultrasound examinations, indicated in another 20 per cent and not indicated in 16 per cent. In 31 per cent increased intraperitoneal effusion was the only finding. There was a tendency towards an underestimation of the injury by ultrasonography. Peritoneal lavage was positive in all examinations.
Spontaneous pneumothorax is not uncommon and can be potentially dangerous, especially in older people. A series of 201 patients is presented. Conservative treatment with tube thoracostomy had a 19% failure rate. It seems nevertheless to be the treatment of choice, though with risk of serious complications. Among the 60 patients who underwent lateral thoracotomy, 30% had recurrence of pneumothorax or other complications. Reoperation because of inadequate pulmonary expansion was necessary in four cases.
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Fifteen patients who developed serious complications from pancreatitis, were treated operatively with one post-operative (cardiac) death. Pancreatic tail resection and cyst exstirpation were used in 6 patients, and pancreatic resection and pancreatic jejunostomy in four. An aggressive diagnostic approach using early ERCP and CT, as well as a persistent operative treatment are highly recommended.
A case of pericardial rupture following blunt thoracic trauma is presented, together with a collective review of the literature. The rising survival rate is due to heightened awareness of this injury, which should be suspected in all patients who have sustained high-energy trauma.
In 109 patients who underwent abdominal aortic reconstruction, the importance of preoperative complicating factors was retrospectively studied. High age at operation, presence of coronary heart disease, heart failure, hypertension, chronic pulmonary disease and renal failure, heavy smoking and alcoholism were among the investigated factors. A simple preoperative risk score was defined, based on the number of such complicating factors present in each case. Although the operation was technically uncomplicated in all 109 patients, 15 required intensive care for more than 4 days and seven died. Morbidity and mortality were heightened in cases with more than three risk factors. Coronary heart disease and renal failure were the most important risk factors.