[The Orebro pleural drainage constructed at the clinic].
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Drainage↗
Biomedical subjects
L Dernevik
Publications and source records attributed to L Dernevik.
Shrinking pleuritis with atelectasis.
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Asbestos↗
Long-term follow-up of operative treatment for pulmonary metastases.
From 1954 onwards, 132 patients underwent 165 resections for pulmonary metastases. No other forms of therapy were adopted. The operative mortality was 7.6% (10 patients). After a minimum follow-up of 5 years, the overall survival rate was 20%. The 10- and 15-year survival rates were 6% and 3%, respectively. The major cause of late death was recurrence or spread of the primary disease in 102 patients (83.6%) while 5 patients died of reasons not related to cancer. Fifteen patients (12.3%) are still alive, 13 of whom have no clinical cancer. The presence of symptoms, the disease-free interval of less than 1 year and the number of metastases showed a statistically significant detrimental influence on survival (P less than 0.001, P less than 0.05 and P less than 0.046, respectively). The best 5-year survivals of 42%, 24%, 23% and 23% were noted for metastases from malignancies in the body of the uterus, kidney, bone and colon, respectively. Longterm survival or clinical cure can be achieved with surgery alone by an aggressive approach in selected malignancies.
Adolescent↗
Torsion of a lung lobe: diagnosis and treatment.
Intraoperative lobar torsion occurred in 4 of about 2000 patients subjected to thoracotomy. Two of the patients died. Early diagnosis and proper management are of great importance to the outcome. Temporary deflation of the diseased lung by using double lumen endobronchial tube is a potential risk. Early progressive lobar opacity without signs of atelectasis on conventional chest radiograph is indicative of this serious complication. Computerized tomography and bronchoscopy are of diagnostic value. Exploratory thoracotomy must be performed without delay. The injured parenchyma should be sacrificed unless the diagnosis is obtained very early. When the injured lobe or lung is rotated back into normal position the airways may be flooded with serosanguinous fluid which promptly has to be removed. If an attempt is made to save the lobe or the lung, tracheostomy for frequent suction of the airways is indicated in order to prevent "spill-over" and dangerous postoperative hypoxia.
Adult↗
Enzymatic activities in heart and skeletal muscle of children with cyanotic and noncyanotic congenital heart disease.
The activity of phosphofructokinase (PFK), citrate synthetase (CS), lactate dehydrogenase (LDH), 3-OH-CoA dehydrogenase (ACDH) and cytochrome-c-oxidase (cyt-ox) was measured in right atrial auricle and abdominal rectal muscle biopsies from 24 children, aged 3-12 years, with congenital heart malformations. Twelve children had cyanotic conditions (tetralogy of Fallot or truncus malformations) and 14 were noncyanotic (septal defects or vascular lesions). The cyt-ox activity was significantly higher in the cyanotic subgroup than in the noncyanotic (skeletal muscle: 55.71 +/- 10.4 vs 19.48 +/- 2.6 mmol/g protein/min, p less than 0.01; auricle: 93.1 +/- 11.8 vs 65.58 +/- 7.5, p less than 0.05). There were no significant differences between the activities of PFK, LDH, CS or ACDH in the cyanotic and noncyanotic groups. Within the normal range of hemoglobin and hematocrit, there was no correlation between these parameters and cyt-ox. On the other hand, above the normal range of hemoglobin and hematocrit a correlation coefficient of 0.89 (p less than 0.01) was observed which suggests the higher cyt-ox activity to be an adaptive phenomenon triggered by reduced availability of oxygen.
3-Hydroxyacyl CoA Dehydrogenases↗
Reduction of post-thoracotomy pain by cryotherapy of intercostal nerves.
In a prospective study, 144 patients undergoing thoracotomy were randomized to two groups: In 71 cases cryoanalgesia was applied intraoperatively to the intercostal nerves above and below the incision to relieve postoperative pain, and 73 (control group) received bupivacaine-adrenaline intercostal blockade at the end of the operation. The amount of administered narcotic and mild analgesics, the visual analogue pain scores, the need for further intercostal blockade and the number of postoperative bronchoscopies to clear retained secretion were significantly less in the cryoanalgesia group than in the controls. There were no late nerve complications after cryoanalgesia, which is recommended for routine use in thoracotomy.
Analgesia↗
Clinicopathologic studies on mesothelioma of the pleura. Differentiated approach to treatment.
A surgical series of 23 patients with pleural mesothelioma is reviewed. Three who had benign localized mesothelioma of fibrous type are alive and well at least 10 years postoperatively. In two others, radically extirpated localized mesothelioma was histologically classified as benign, but later proved to be malignant, causing death from recurrent disease 27 and 79 months postoperatively. Four patients with diffuse malignant mesothelioma underwent pleurectomy or open biopsy and survived for 2-9 months. Radical en-bloc pleuropneumonectomy was performed on 14 patients with diffuse malignant mesothelioma. One patient died postoperatively and the others succumbed to the disease after 3-51 (mean 20) months. The survival time was greater than or equal to 1 year in 62% of the patients and greater than 3 years in 23%. Patient age, histologic tumour type and extent of disease seemed to be important prognostic factors. Despite the generally poor prognosis, the results of radical surgery in this study appear to warrant an aggressive approach to treatment of benign or localized malignant pleural mesothelioma, and possibly also to stage I diffuse malignant mesothelioma of epithelial type.
Adult↗
[Atelectatic pleural shrinking--a benign round mass in the lung in patients exposed to asbestos].
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Asbestos↗
Inadvertent transarterial pacemaker insertion: an unusual complication.
We describe an unusual complication of pacemaker treatment in a patient who died after a replacement operation. In a difficult situation in which a functioning pacemaker was highly desirable and in which most of the available veins had already been used, the pacemaker electrode was inserted, by mistake, through a small artery. This was not detected by fluoroscopy during surgery. The postoperative X-ray examination seemed to indicate that the electrode tip was located in the coronary sinus, but the subsequent autopsy revealed it to be located in the left ventricle.
Aged↗
Concomitant lung cancer and surgical heart disease.
Concomitance of pulmonary carcinoma and heart disease poses problems of management. We encountered this disease combination in 6 of 2,139 patients operated on with extracorporeal circulation during a 5-year period. Our policy has been to correct the heart disease first. The tumour was subsequently operated on in five of the six patients, but the sixth was subjected only to excisional biopsy of malignant tumour nodules during the heart operation. There was no operative mortality. Three patients died in the follow-up period. A treatment strategy is suggested, based on our experience and on a review of the literature.
Female↗
Pathogenesis of shrinking pleuritis with atelectasis--"rounded atelectasis".
The pathogenesis of "shrinking pleuritis with atelectasis" or "rounded atelectasis" is discussed on the basis of 37 operated patients and on experiments on cadaver lungs. Peroperative dissections with microscopic examinations and the results of experiments with the cadaver lungs support the concept that the lesion is caused by an inflammatory reaction in the visceral layer of the pleura, caused by asbestos fibers. The inflammation occurs in stages, with deposition of connective tissue that shrinks and causes considerable atelectasis of the underlying pulmonary parenchyma. Compression of the lung due to fluid collecting in the pleural cavity involved was not noted.
Asbestos↗
Treatment of benign strictures and injuries of the oesophagus with a permanent oesophageal tube introduced through a cervical oesophagostomy. I. Method.
Permanent oesophageal tubes of various design have been used for treatment of severe benign oesophageal strictures and oesophageal injuries. A method in which the tube is introduced into the oesophagus through cervical oesophagostomy as proposed by Belinoff is presented and technical details are discussed.
Catheterization↗
Treatment of benign strictures and injuries of the oesophagus with a permanent oesophageal tube introduced through a cervical oesophagostomy. II. Clinical observations.
Eighty-four patients with severe benign oesophageal strictures and/or oesophageal perforation have been managed with a permanent oesophageal tube (POT) introduced through a cervical oesophagostomy. Sixty-eight patients had severe strictures of varying etiology. In these patients, the conservative treatment by bouginage could not be continued due to a stricture unyielding for dilatation or early recurrence of the stricture after a number of dilatations. Eleven of these patients had iatrogen oesophageal perforation at the time the treatment with POT was started. In 16 patients indication for treatment with POT was a severe injury of the oesophagus and in 15 of them it was transmural. The results of the treatment are considered to be satisfactory. The mortality rate, the final results and the factors determining poor results of the treatment are discussed. The treatment with POT introduced through a cervical oesophagostomy is considered to be a valuable method which can be used in cases with stricture and injuries of the oesophagus in which conventional conservative treatment is futile or impossible and resection of the oesophagus undesirable.
Adolescent↗
Esophageal perforation during mediastinoscopy--the successful management of 2 complicated cases.
Esophageal injury during mediastinoscopy is a rare and easily overlooked complication. In this paper 2 complicated cases, one associated with a pulmonary artery lesion, are reported. Both patients eventually recovered. The principles of management are discussed based on these cases.
Aged↗
Exogenous particles in lymph nodes in patients with shrinking pleuritis with atelectasis.
Shrinking pleuritis with atelectasis is a disease in which a compression atelectasis of the lung is caused by shrinking of the inflamed visceral pleura. This reaction has been attributed to asbestos. By means of scanning electron microscopy, with computerised x ray spectrophotometry and x ray diffraction analysis, tissue samples from the lymph nodes of patients with the disease and control subjects were examined for other particles of possible aetiological importance. The results would suggest, however, that asbestos is the most important factor in the aetiology of shrinking pleuritis with atelectasis.
Asbestos↗
Long term results of operation for shrinking pleuritis with atelectasis.
During 14 years 34 patients were operated on for shrinking pleuritis with atelectasis. They were followed up after one to 14 years (mean 6.0) by interview, chest radiography, and spirometry. Most were in good condition, but a reduction in vital capacity had occurred in eight and in FEV1 in 15 patients. Radiographs were normal in 28 patients except for small pleural or parenchymal fibrotic changes. One patient had a suspected recurrence of shrinking pleuritis with atelectasis after nine years, suggesting continuation of the disease process despite operation.
Adult↗
Surgical removal of pulmonary metastases from renal cell carcinoma.
Thirty-three patients operated on for pulmonary metastases from renal cancer were followed up for a minimum of 5 years or to death. The 5-year survival was 21%. There was a tendency to better survival in patients operated by lobectomy rather than limited resection. Extended operations carried a grave prognosis. Manifest metastatic disease within one year after the primary operation showed shortened survival. Repeated operations were possible, with good results. It is concluded that operations for pulmonary metastases can be performed with good results. However, the effect is a palliative one as the ultimate cause of death in all instances was the spread of the cancer disease.
Carcinoma, Renal Cell↗
Resectional operations and long-term results in carcinoma of the esophagus.
The 5 year survival rate after resectional operations for carcinoma of the esophagus is still very low. Many factors have been identified as contributing to these poor long-term results. The main factor found in this study, comprising 102 patients undergoing resection out of 125 patients operated upon during a 10 year period, was nonradical resection. The main cause of nonradical resection was invasion of the tumor into the mediastinum, which was observed in 80% of the patients. In 43 of the 102 patients undergoing resection, the penetration of the carcinoma into the tissue surrounding the esophagus was observed only histologically. Thirty-three of the 38 hospital survivors in this group died within 2 years of the operation of recurrence of carcinoma. Fourteen of 17 survivors after resectional operations in whom the tumor growth was still limited to the esophagus were alive from 2 to 9 years (mean 6 years) after the operation, without evidence of recurrence.
Adult↗