Biomedical subjects
Publications and source records attributed to S Hagberg.
Adolescents seen in a general hospital emergency department or psychiatrically hospitalized were followed up at one month and three months following a suicide attempt. Findings included substantial drop-out rates for psychotherapy and high rates of repeated suicide attempts by three months. Implications for disposition planning and care of such adolescents are discussed.
This report reviews 16 years' experience in the management of patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF), with special emphasis on long-term results and early complications in relation to the magnitude of the gap between the esophageal segments. In 94 infants with no or moderate distance between the esophageal ends (less than 2 cm), an end-to-end anastomosis was performed in 90 cases after closing the TEF. In 51 of the 90 patients, no complications were seen (57%), whereas in the remaining 39, postoperative complications were noted with anastomotic leakage (24 patients, 26%), anastomotic stricture (16 patients, 18%) and gastroesophageal reflux (5 patients, 5%). Sixteen patients (9 with and 7 without TEF) had a "long gap" between the esophageal segments (greater than 2 cm). Thirteen (9 with and 4 without TEF) of these 16 patients were subjected to an end-to-end anastomosis, 11 primarily and two secondarily after 3 and 12 weeks, respectively. All 13 patients with an end-to-end anastomosis had anastomotic leakage (100%)--nine had stricture (75%) and 5 had gastroesophageal reflux (50%). The remaining three patients in this long-gap group were subjected to colon transposition, two primarily and one secondarily. The total mortality rate decreased from 19/57 patients (33%) from 1969 to 1977, to 5/53 (9%) from 1978 to 1984. The main cause of death in both periods was associated anomalies (18% and 7%, respectively), whereas deaths related to the EA malformation as such had almost disappeared during the latter period (15% and 2%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Seven cases of prenatally diagnosed gastroschisis were evaluated. All infants were delivered by elective Caesarean section and brought to the operating theatre immediately after birth where the abdominal wall defect was closed within one hour post partum. Primary closure was easy and successful in all cases without widening of the defect and with the umbilicus left intact, because of the total lack of oedema and bowel peel. The average duration of postoperative total parenteral nutrition (7 days) and hospital stay (18 days) was significantly shorter in this prenatally diagnosed group compared to traditionally treated cases.
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The effects of hormonal treatment (LH-RH, LH-RH plus hCG) on undescended testis were studied on 42 testicles in 37 boys under 3 years of age. Descensus was achieved primarily in 40% but eight testicles reascended. A new course of hCG resulted in descensus in three cases. Altogether, therefore, full descensus could be achieved in 29% of cases with hormonal treatment. Hormonal treatment is recommended before surgery.
Ten years experience with Rehbein's procedure in the surgical treatment of Hirschsprung's disease (23 patients) is reported. Eleven patients were operated with a covering colostomy. Clinically overt anastomotic dehiscence was seen in 6/23 patients, being more common in the patients without a colostomy (5/12). Five of the patients with anastomotic dehiscence recovered completely after surgical intervention (4) or conservative treatment (1), whereas one patient ended up with incontinence. One patient died in enterocolitis apparently without relation to the surgical treatment. Early postoperative constipation and soiling were common, whereas at late follow-up constipation was reported only in one patient. At late follow up barium enemas showed a normal colorectal calibre in most patients. Anorectal manometry (n = 8) showed absence of normal rectoanal inhibition and rectal volumes slightly larger than among controls.
In a case-control study asbestos exposure in 64 consecutive men with idiopathic pleural effusion and 129 randomly sampled age matched male controls was compared. Furthermore, seven women and 64 men with idiopathic pleural effusion were studied, including a three year re-examination, in an attempt to identify characteristics that might distinguish asbestos exposed from non-exposed patients. Asbestos exposure was significantly (p less than 0.01) more frequent in men with idiopathic effusions than in controls. The idiopathic effusions seen in asbestos exposed patients were compatible with the diagnosis "asbestos pleural effusion." Two features were characteristic of patients with asbestos pleural effusion: a chest radiograph at the initial examination showing converging pleural linear structures or rounded atelectasis or a history of recurrent pleural effusion, or both.
From 1969 to 1982, 15 cases of long-gap esophageal atresia were treated. Twelve patients could be managed by direct end-to-end anastomosis - ten primary and two delayed. Anastomotic leakage was noted in all patients, causing anastomotic obstruction in nine, which had to be treated with repeated esophageal dilatations. In one patient the esophageal dilatation resulted in esophageal perforation, with a fatal outcome. The remaining 11 patients are all doing well. Three patients were subjected to colonic transposition, two primary and one delayed according to Waterston. One of these subjected to primary colonic transposition died postoperatively from cerebral hemorrhage. The other one is now doing well after resection of the transposed colonic segment which fibrotized but could be resected, after which the esophageal ends could be anastomosed. The patient subjected to delayed colon transposition is also free of major swallowing problems following immediate postoperative anastomotic stricture which could be managed by repeated dilatations.
Floorlayers and age matched carpenters with long (greater than or equal to 20 years) and short (5-10 years) occupational experience were compared with respect to chronic and acute neuropsychiatric, neuropsychological, and general health effects as related to different types of solvent exposure. An increased prevalence of neuropsychiatric illness occurred among floorlayers with long occupational experience, possibly caused by high levels of exposure which were present until the 1970s. The disease appears partly reversible since, at the time of the investigation, all had essentially recovered. Some impairment of performance in psychological tests was seen, however, in this group. Visuoanalytical impairment was associated with indices of exposure to glues based on alcohols whereas contact adhesives appeared more deleterious to perceptual functions. The increased prevalence of neuropsychiatric symptoms among the floorlayers was interpreted to reflect mainly acute effects on the central nervous system.
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The mortality of children with posterolateral diaphragmatic hernia (PDH) is mainly dependent upon the degree of lung hypoplasia. Other less significant factors are dysmaturity, associated anomalies, infection and haemorrhages. Children with grave cyanosis from PDH immediately after birth have a poor prognosis due to persistent foetal circulation with pulmonary vascular hypertension and right-left shunting. A better understanding and treatment of this persistent foetal circulation may considerably improve the surgical mortality, though in some cases the lung hypoplasia may be too far advanced.
Ten cases of posterolateral diaphragmatic hernia have been operated upon the last two years. Three cases of these have successfully been operated in conventional way. In seven cases ductus arteriosus was closed. Only two cases survived. A preoperative evaluation is to be done. Depending on the blood-gas-analysis, the cases can be divided into cases belonging to the survival zone and cases belonging to the fatal zone according to Boix-Ochoa. If it is possible to increase the oxygen uptake and to expire the carbonic acid, the results seem to be good after conventional operation. If it not will be possible to increase the oxygen saturation and not even possible to reduce the CO2 pressure with a ventilator with 100 per cent oxygen, the cases are to be considered inoperable. In fatal zone cases, where a reduction of PCO2 is possible, but there are no possibilities to get an increased oxygen saturation, an operative closing of ductus can be tried if heart anoxia is treated with the aid of an oxygenator.
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