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Biomedical subjects

O Soreide

Publications and source records attributed to O Soreide.

18 recordsLinked to original sources

Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience.

OBJECTIVE: To study factors influencing complications and death after operations for small bowel obstruction (SBO) using multifactorial statistical methods. SUMMARY BACKGROUND DATA: Death after surgery for SBO is believed to be influenced by factors such as old age, comorbidities, bowel gangrene, and delay in treatment. No studies have been reported in which adverse factors related to death and complications have been systematically investigated with modern statistical methods. METHODS: The authors studied retrospectively 877 patients who underwent 1,007 operations for SBO from 1961 to 1995. Patients with paralytic ileus, intussusception, and abdominal cancer were excluded. Odds ratios for death, complications, postoperative hospital stay, and strangulation were calculated by means of logistic regression analyses. RESULTS: Death and complication rates decreased during the study period. Old age, comorbidity, nonviable strangulation, and a treatment delay of more than 24 hours were significantly associated with an increased death rate. The rate of nonviable strangulation increased markedly with patient age. Major factors increasing the complication rate were old age, comorbidity, a treatment delay of more than 24 hours, and the need for repeat surgery. CONCLUSION: Death and complication rates after SBO decreased from 1961 to 1995. Major factors influencing the rates were age, comorbidity, nonviable strangulation, and treatment delay. Nonviable strangulation was more common in old patients.

Age Factors↗

[Can we rely on Norwegian surgery data? A quality control at central and local hospitals of the procedure codes used in the survey on organization of gastrointestinal cancer surgery].

The nation-wide register of hospital discharges in Norway includes ICD-9 and national procedure codes. Hospitals were asked to check five surgical procedures listed in the register against the primary data sources. 649 discharges were controlled. The response rate was 68%. The results indicate that the quality of the data in the register varies for the different procedures. For procedures with high volume (resection of rectum), the error in the register is 3%. This is the same as reported from other Nordic countries. The proportion of errors in the register was high in hospitals with only one registered procedure code. The quality of data can to some extent be checked on the basis of DRG coding (DRG group 468/477). Quality control of register data is required when the number in DRG 468/477 is high in the nation-wide register or when the number of specific procedures in hospitals is low.

Databases, Factual↗

Hemobilia. A disease in evolution.

Ten patients with hemobilia were treated over a six-year period. Six cases resulted from iatrogenic injury (percutaneous invasive procedures, four; surgical trauma, two); the others were caused by gallstone disease (two), liver trauma (one), and vasculitis (one). Five patients were treated successfully by selective arterial embolization. In the other five patients, embolization was not possible due to previous surgical and/or radiologic procedures, or it was contraindicated, and thus, surgical treatment was undertaken. One of these patients died. There were no long-term sequelae in the remaining nine patients followed up for 12 to 66 months. Selective hepatic arterial embolization is the treatment of choice for hemobilia. Inappropriate embolization or surgery frequently fails to control the bleeding and may also prevent later successful embolization.

Adult↗

The management of fistulas of the biliary tract after injury to the bile duct during cholecystectomy.

Twelve of 123 patients who were treated for benign stricture of the bile duct after cholecystectomy presented with an external fistula of the biliary tract. Nine of these patients had undergone multiple operations prior to referral, six having undergone earlier attempts at repair of the bile duct. Two patients initially required urgent laparotomy for drainage of infected abdominal collections. Distal obstruction of the bile duct below the origin of the fistula was present in five patients. Repair of the bile duct was undertaken after careful investigation and correction of nutritional, fluid and electrolyte status in five patients who had little prospect of spontaneous closure of the fistula. The other seven patients were initially treated conservatively; in three, the fistula closed at five to nine weeks without complication, and no further surgical treatment has been required (a range of six to 36 months). The remaining four patients required delayed operation after the development of cholangitis or jaundice. The overall median survival time between development of fistula and operative repair was 3.5 months, and all nine of these patients remained asymptomatic with normal results from liver function tests (a median follow-up period of 17 months). The need for careful initial assessment prior to repair of the bile duct and the possibility of conservative treatment for patients with a postcholecystectomy fistula of the biliary tract are emphasized.

Adult↗

Primary non-Hodgkin's lymphoma of the liver.

A patient with irresectable primary non-Hodgkin's lymphoma of the liver (histiocytic type, Rappaport classification) is presented. Systemic chemotherapy combined with local irradiation were successful in achieving a disease-free interval in a follow-up of 36 months. Review of the literature disclosed 19 other patients previously reported, with considerable variations in extent of disease at presentation. Criteria for the diagnosis of primary non-Hodgkin's lymphoma are proposed, and 11 patients met these criteria. Hepatic resection is advocated for localized tumour, while systemic chemotherapy and local irradiation in patients with irresectable tumours were found effective in achieving local and systemic control in a mean follow-up of 37 months.

Antineoplastic Combined Chemotherapy Protocols↗

Characteristics of fibrolamellar hepatocellular carcinoma. A study of nine cases and a review of the literature.

Clinical and laboratory data for nine patients with hepatocellular fibrolamellar carcinoma treated at our institution have been summarized with emphasis on the relevance of plasma neurotensin levels as a tumor marker. The mean age of the patients was 22 years. Seven underwent hepatic resection, and two of these had later surgical removal of recurrent disease. Plasma neurotensin levels were initially elevated in five of the seven patients in whom it was measured. Neurotensin levels were within normal limits in three of four patients with recurrent disease, but were elevated in one patient who also had elevated plasma neurotensin levels preoperatively. In addition, a review of 80 patients reported since 1980 was performed. The mean age of these patients was 23 years, and only 6 percent were older than 50. The male to female ratio was 3:4. Eight percent were positive for hepatitis B antigen and 11 percent had elevated alpha-fetoprotein levels. Four percent had cirrhosis of the liver. The resectability rate was 58 percent. Five year survival for patients who underwent hepatic resection was 56 percent. Patients treated nonsurgically had a median survival of 13 months, and none of these patients lived for 5 years. Fibrolamellar hepatoma seems to be a distinct clinical entity that mainly occurs in young patients. The prognosis in patients treated with a curative resection is good. Plasma neurotensin levels may be of value as a tumor marker, but further studies are necessary to substantiate this theory.

Adolescent↗

Liver atrophy complicating benign bile duct strictures. Surgical and interventional radiologic approaches.

The hepatic atrophy and hypertrophy complex has been described in a selected group of nine patients with benign bile duct stricture. The clinical features common to this group were a high biliary stricture and a long-standing history of cholangitis and intermittent jaundice. A history of multiple surgical procedures and associated vascular damage or portal hypertension is strongly suggestive of the atrophy and hypertrophy complex. The radiologic criteria for the diagnosis of this condition are presented. Computerized tomography and HIDA scintigraphy were valuable as noninvasive means to diagnose lobar liver atrophy. The atrophy and hypertrophy complex described herein poses significant therapeutic problems and demands approaches other than those normally applicable for high biliary strictures. A combined surgical and radiologic approach with additional interventional radiologic procedures may be appropriate in patients in whom hilar anastomosis is difficult or impossible.

Adult↗

The radiology of fibrolamellar hepatoma.

Seven patients with fibrolamellar hepatoma were examined with computed tomography (CT), ultrasonography and angiography. On CT the tumours were large, of low attenuation, had a well-defined edge and some contained areas of calcification or necrosis. Ultrasonography revealed well-defined masses of mixed echogenicity, occasionally involving the portal vein. In one patient there was dilatation of the intrahepatic biliary tree. Arteriography showed vascular tumours with involvement of the portal vein in five cases and compression of the inferior vena cava in five cases. CT and ultrasonography are the most useful radiological investigations for suggesting the diagnosis of fibrolamellar hepatoma which should be considered in the case of any large solitary well-defined hepatic tumour in the noncirrhotic liver of a young person.

Adolescent↗

Pneumoperitoneum without clinical peritonitis due to bilateral pyosalpinx.

A case of pneumoperitoneum without clinical peritonitis due to bilateral pyosalpinx is presented. This clinical condition has in the literature been called "spontaneous or idiopathic pneumoperitoneum", and conservative treatment in such cases has been advocated. As shown in our case severe intraperitoneal pathology may exist, and we therefore advocate early explorative laparotomy in all patients with pneumoperitoneum without peritonitis.

Aged↗

effect of kidney resection on blood pressure and plasma renin activity. Case report and clinical study.

Acute transient hypertension following kidney trauma occurred in a 17-year-old youth due to increased activity of the renin/angiotensin system. The systemic blood pressure and plasma renin activity was also studied following elective kidney resection. In one group of patients the operation was performed with clamping of the renal vessels; in the other no clamping was performed. Only minimal changes in blood pressure and plasma renin activity was found in both groups.

Acute Disease↗

A new design of the Christiansen endoprosthesis. Report of two cases in which separation of the two components of the prosthetic head occurred.

Primary prosthetic replacement in elderly patients with displaced intracapsular fracture of the femoral neck has been used during the last few years with encouraging early results. The prosthetic device preferred has been Christiansen's endoprosthesis. During the past year a new type with separable plastic head and metallic cap has been used. This modification has resulted in the occurrence of a previously unknown complication, a separation of these two parts, necessitating reoperation and insertion of a new head piece. The possible mechanisms causing this separation are discussed.

Aged↗

Primary prosthetic replacement in acute femoral neck fractures.

This paper reports a retrospective study of acute femoral neck fractures in 123 patients treated by primary prosthetic replacement. The average age in our patient population was 80-5 years. A Christiansen trunnion-bearing hip prosthesis (Christiansen, 1969 and 1974) was used in all patients except one. The prosthesis was cemented to the femoral shaft. The postoperative mortality rate was low, and the mortality rate was 8-7 per cent. The patients were examined between 6 months and 3 1/2 years after operation. Excellent or good results according to Stinchfield's hip assessment system (Stinchfield et al., 1957) were obtained in 82 per cent of the patients. We suggest that primary prosthetic replacement in acute femoral neck fractures in elderly patients is a safe and valuable procedure. However, a definite conclusion concerning this therapy cannot be drawn before a prospective study comparing the results of internal fixation and primary prosthetic replacement is made.

Acute Disease↗