[Tweezers are excellent tick removers].
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Animals↗
Biomedical subjects
L Okmian
Publications and source records attributed to L Okmian.
Computed tomography and magnetic resonance tomography findings in children operated for anal atresia.
Computerised tomography and magnetic resonance tomography were performed in nine faecally incontinent patients more than eight years after rectoplasty for high imperforate anus. No statistically significant correlation was found between function, i.e. degree of faecal incontinence, and anatomical findings. Thus, in spite of a detailed demonstration of the post-operative anatomy, the information does not seem to be directly applicable in indicating a way to reoperate for faecal incontinence in this group of patients.
Adolescent↗
No correlation between hyperthermia during pregnancy and Hirschsprung disease in the offspring.
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Female↗
Reconstruction of the thoracic esophagus using autotransplanted small intestine--an experimental study in the piglet.
An experimental method is reported for bridging defects of the thoracic esophagus, using a free jejunal graft connected to the aorta by microvascular anastomoses. The advantages of this method are that defects are bridged by vital and well-vascularized tissue and that only short bowel segments are required. Drawbacks seen in animal experiments are a relatively difficult operative technique and a high complication rate. This high complication rate might be lowered in infants under intensive-care conditions.
Animals↗
Physiotherapy to improve faecal control after Stephens' rectoplasty in high imperforate anus.
The role of physiotherapy for the achievement of faecal continence after Stephens' rectoplasty for high imperforate anus was studied. Clinical assessment and ano-rectal manometry were performed more than 7 years after surgery, both before and after one year of physiotherapy training of the perianal musculature. After the training period the faecal control improved. This effect was verified by the ano-rectal manometry findings. Faecal continence can be achieved by Stephens' rectoplasty. Furthermore, with any persisting incontinence, postoperative physiotherapy with training of the voluntary muscles in the perianal region can be valuable for the achievement of faecal continence.
Adolescent↗
Circumcision for phimosis--indications and results.
A follow-up study including all boys (n = 117) operated with circumcision for phimosis during 1976 was performed. Most patients were operated on an outpatient basis. Early complications like bleeding or infection were few and mild. In 13 cases there was a postoperative stricture of the urethral orifice which had to be widened. Five patients had complaints about the cosmetic result. Eight boys expressed shyness and unwillingness to undress in school gym. In no instance were there any signs of a more serious psychological disorder. The operative indications are discussed and it is concluded that worried parents of boys with phimosis can be safely advised to have their boys circumcised if the prepuce is scarred or there has been recurrent balanitis, or if the boy has reached school age and the foreskin is still unretractable.
Child↗
Circumcision for phimosis: a follow-up study.
All 117 boys circumcized for phimosis during one year at the Department of Pediatric Surgery in Lund were subject to a follow-up study five years postoperatively. In 45 cases the main operative indication was recurrent balanitis, in 25 cases scarring of the prepuce and in 41 cases an expressed ballooning at voiding. Early operative complications included 7 cases of postoperative haemorrhage which in 1 case necessitated reoperation. In 1 case there was a postoperative infection. 13/117 patients developed a stricture of the urethral orifice necessitating meatotomy. The study included a questionnaire which was answered by 97/117 patients, 92 of whom expressed complete satisfaction with the operation. The complaints of the others were cosmetic in nature. There was in no instance any sign of more severe psychological disorder than a certain shyness which was expressed in 8 cases. It is concluded that circumcision for phimosis in young boys is complicated by meatal stenosis in a certain frequency (13/117) but not loaded with serious complications. There seems to be no reason to fear psychological disturbances due to circumcision.
Child↗
Effect of loperamide on faecal control after rectoplasty for high imperforate anus.
The effect of loperamide on faecal control after Stephens rectoplasty for high imperforate anus was studied in eight patients more than 8 years after surgery. Clinical assessment and anorectal manometry were performed before and after administration of loperamide for 6 to 8 weeks. Decreased faecal soiling was noted in seven of the eight cases. Obstipation forced two patients to stop the medication. The improved faecal control was verified by an increase in squeeze pressure at anorectal manometry in four patients. When incontinence persists after Stephens rectoplasty, loperamide can improve the faecal control in some cases.
Adolescent↗
End-to-end anastomosis in oesophageal atresia--clinical application of experimental experiences.
During the 70's, several investigations were made concerning the healing of oesophageal anastomoses under experimental conditions. The experiences were successively applied to the treatment of oesophageal atresia. Between 1969 and 1982, a total of 49 patients were operated upon with primary end-to-end anastomoses. The material was divided in an earlier and a later series. The result of the later series was better with respect to anastomotic leakage, strictures and mortality. This might be the effect of the modified treatment according to the clinical application of the experimental experiences reviewed in this paper.
Colon↗
Technical considerations of experimental esophageal anastomosis.
Following transection and anastomosis of the intrathoracic esophagus, the effects of rotating the esophageal ends, lumen-widening procedures, microsurgical technique and traction sutures were studied in 8 series of 10 piglets each. The results were evaluated with contrast-medium X-ray examination and macrophotography. The different procedures were compared with single-layer end-to-end anastomosis with 6/0 silk. Anastomosis with 10/0 supramid withstood the tension in the intrathoracically stressed esophageal anastomosis, but gave no advantages. Rotating of the ends of the transected esophagus showed no significant differences. Widening the anastomotic lumen with longitudinal incisions did not result in a wider lumen. Further extension of the anastomotic circumference with a Z-shaping of the mucosa did not reduce stricture formation. Traction sutures between the esophageal wall and perivertebral fascia gave a significantly wider anastomotic lumen. There was no correlation between stricture, and the amount of granuloma, submucous leakage, or degree of histologic change.
Animals↗
Ultrasonic diagnosis of testicular torsion.
An ultrasonic technique to avoid errors in the diagnoses of acute testicular torsion is described. The presence or absence of intratesticular arterial pulsation was recorded and analysed. The technique may reduce diagnostic failures and the number of scrotal explorations of nontorquered testis.
Child↗
Bedside calculation of body surface area for infants and children.
In 179 healthy boys and girls, the relationship between body surface area (S) in dm2 and body weight (bw) in kg was investigated. The body surface was calculated from the DuBois and DuBois formula. For infants below 20 kg, the relationship followed the regression equation S=3.6kg + 9; r=0.996. For infants with bw between 20-40 kg, the regression equation S=2.5.kg + 33; r=0.977 was found. These equations can easily be memorized and may be able to replace nomograms when bedside calculations of the S is required. In addition, formulas for the volume of plasma expander to be used in the prophylaxis and treatment of shock, trauma, and burn injuries are presented.
Body Height↗
Reconstruction of the thoracic oesophagus using autotransplanted small intestine. An experimental study in the piglet.
A technique for overbridging thoracic oesophageal defects with revascularized intestinal autotransplants was evaluated in 32 piglets. A microvascular end-to-side anastomosis was performed between the 1.5 mm transplant artery and the aorta. Specially constructed vascular scissors were used to cut a suitable opening in the aorta. The venous anastomosis was performed between the transplant vein and the hemiazygous vein. After partial oesophageal resection, the revascularized autotransplant was interposed between the oesophageal ends and anastomosed. The series carried a high rate of complications, but the study showed, however, that the technical prerequisites exist to perform this kind of operation.
Animals↗
Peptidergic nerves persist after jejunal autotransplantation: an experimental study in the piglet.
The gut has been shown to contain four types of peptidergic nerves besides the adrenergic and cholinergic ones. They store substance P, enkephalin, somatostatin and VIP (vasoactive intestinal peptide) respectively. It is not previously known which of the neurons are intrinsic or extrinsic to the gut wall. Jejunal autotransplantation was performed in 10 piglets. This procedure implies degeneration of the extrinsic neurons (extrinsic denervation). The transplants were examined 1 to 4 mo postoperatively with histochemical techniques for demonstration of the intramural adrenergic and the different peptidergic nerves. The distribution of the peptidergic nerves was not changed indicating that they all originate within the gut. Following extrinsic denervation adrenergic nerves on the contrary were completely missing.
Animals↗
[A new type of breathing apparatus].
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Humans↗
Experimental studies on artificial ventilation using a tidal volume ventilator. Mechanics and dynamics of ventilation.
In 24 piglets (2.7-24.5 kg b.w.), the mechanics of ventilation, the accuracy of dosage of respiratory volumes, and the influence of the ventilator's volume/pressure characteristics (Cvent, "internal compliance") on the dynamic course of insufflation were studied. A linear relationship was shown to exist between tidal volume and end-inspiratory tracheal pressure and between tidal volume and insufflation time. The insufflation time was reduced to about 50% of previously registered values. The error between set and registered tidal volume was found to be 6.0 +/- 2.7%. During the insufflation a linear relationship was found between the instant amount of delivered breathing gas and the corresponding endotracheal pressure change. The ventilator's Cvent did (and body size, total compliance and tidal volume did not) significantly influence the size of the direction coefficient for the linear instantaneous volume/pressure relationship, the magnitude of tracheal peak pressure and a short insufflation time, and vice versa. The use of greater power from the ventilator resulted in a significant shortening of the duration of insufflation and vice versa. The duration of insufflation is the parameter of choice in evaluating the efficiency of the ventilatory equipment. When the ventilator's performance is defined, measurements of the duration of insufflation may enable evaluation of conditions within the lungs.
Animals↗
The circulatory response to specific ventilatory patterns using a tidal volume ventilator.
The circulatory response to different ventilatory patterns during artificial ventilation was examined in 17 sternotomized piglets. A constant CO2-tension level was maintained in all investigations by reference to analyses of the end-tidal infra-red CO2 fraction and arterial CO2-tension. The greatest variation in mean values for end-tidal CO2-tension was 0.2 kPa. Total compliance and lung compliance were lower at a ventilator volume/pressure quotient of 20 compared to those at 80 ml/kPa, and at f = 30 compared to f = 11 cycles/min. Higher cardiac output, lower pulmonary vascular resistance and systemic vascular resistance were measured at f = 11 (inspiration 20%) than at f = 30 (inspiration 50%). An increase in inspiration time by about 100% at the lower ventilatory frequency (f = 11) resulted in a significant but uncompensated decrease in cardiac output and stroke volume. These results demonstrate the value of a rapid insufflation in order to give longer expiration time per minute for the benefit of the venous return and cardiac output.
Animals↗
Influence of ventilatory frequencies and ventilator volume/pressure quotients on pulmonary ventilation using a tidal volume ventilator.
The influence of ventilatory frequency and the ventilator's "internal state of gas compression" (Cvent) on mechanics of ventilation, pulmonary ventilation, gas distribution, gas exchange and lung perfusion was studied with free airway and experimental regional airway obstruction in 10 piglets (7-12 kg b. w. ), using a tidal volume ventilator. The VDphy/VTexp ratio was greater at f = 30 than at f = 10.3 cycles/min. This could be related to a significant increase in the VDanat/VTexp ratio at f = 30, while VDc/VTexp and VDlav/VTexp were unchanged at both frequencies. With regional ventilation and perfusion within the obstructed pulmonary field were reduced, compared to the values at f = 10.3 cycles/min. With Cvent 20 ml/kPa, the tidal volumes were insufflated in a shorter time and with a higher initial tracheal peak pressure than with Cvent 80 ml/kPa. Following bronchial obstruction, VA, RQ and Pao2 were greater with Cvent 20 than with Cvent 80 ml/kPa. With Cvent 20, the ventilation of the lung bases was reduced, which was compensated for by a large increase in ventilation within the apical areas of the lungs, while gas distribution within the unobstructed areas was more evenly distributed with Cvent 80. Ventilation at Cvent 20 showed no essential advantage over Cvent 80. Only in lungs extremely difficult to ventilate and with ventilatory frequencies over 50 cycles/min could possible indications for Cvent 20 be seen.
Animals↗