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Svend Schulze

Publications and source records attributed to Svend Schulze.

16 recordsLinked to original sources
PubMed2005

[Diagnostic laparoscopy under local anaesthesia].

Laparoscopy under local anaesthesia (LULA) is a safe, feasible and well-tolerated procedure. LULA has been successfully used for such outpatient gynaecological procedures as diagnosis of chronic pelvic pain and sterilisation. Single studies have indicated that LULA can be performed for diagnosis of possible intra-abdominal catastrophe in ICU patients, appendectomy and preperitoneal inguinal hernia repair. LULA in abdominal surgery for diagnosis of conditions presenting with acute lower abdominal pain is being introduced at our institution. This paper describes the possible applications of LULA in current practice as well as the technical aspects of the procedure.

Abdomen, Acute↗
PubMed2005

[Treatment of gallstone pancreatitis in Denmark].

INTRODUCTION: The aim of the study was to describe the treatment of gallstone pancreatitis in Denmark and to compare it to the recommendations given in the National Reference Programme for the treatment of patients with gallstone disease. MATERIALS AND METHODS: A questionnaire was sent to the 42 general surgical hospital departments in Denmark. RESULTS: All of the departments returned the questionnaire. All of them treated patients with gallstone pancreatitis; 40 of them performed laparoscopic cholecystectomy. The severity of gallstone pancreatitis was estimated in 29 departments. In patients with mild gallstone pancreatitis, 6 departments used ERCP in the evaluation of choledocholithiasis. In patients with mild gallstone pancreatitis who did not undergo an ERCP procedure with sphincterotomy, 13 departments performed laparoscopic cholecystectomy during the same admission after an acute attack. DISCUSSION: In agreement with the recommendations given in the National Reference Programme, the majority of Danish surgical departments used laparoscopic cholecystectomy in the treatment of patients with gallstone pancreatitis who had not undergone ERCP with sphincterotomy. To avoid the high recurrence of gallstone pancreatitis, laparoscopic cholecystectomy during the same admission is recommended. This recommendation was, however, followed by less than half of the surgical departments.

Acute Disease↗
PubMed2005

ECG changes during endoscopic retrograde cholangio-pancreatography and coronary artery disease.

OBJECTIVE: Myocardial ischaemia has been described during endoscopic retrograde cholangio-pancreatography (ERCP), but the pathogenesis remains unclear. The aim of the present study was to evaluate whether coronary artery disease was present in patients with ST-segment changes during ERCP. MATERIAL AND METHODS: Forty patients were monitored with a Holter tape recorder during ERCP. Patients with ST-segment deviation during ERCP subsequently underwent a standard exercise ECG test. RESULTS: Twelve patients developed signs of myocardial ischaemia during ERCP (30%) and 9 had concomitant tachycardia. None had a cardiac history or cardiorespiratory symptoms. Ten of the 12 patients did an exercise test and one patient developed silent ischaemia. Subsequent coronary angiography showed no evidence of coronary artery disease. CONCLUSIONS: No signs of existing coronary artery disease were found in patients developing ST deviation during ERCP when evaluated with a 12-lead exercise ECG test. Further studies should evaluate other mechanisms responsible for myocardial ischaemia during ERCP.

Adult↗
PubMed2004

Complications of ERCP: a prospective study.

BACKGROUND: Studies of ERCP-related morbidity seldom include a sufficient patient follow-up. The aim of this study was to characterize and to evaluate the frequency of complications, cardiopulmonary untoward events in particular. METHODS: All patients undergoing ERCP during a 2-year period were included in this prospective study. Complications were assessed at the time of ERCP and by postal/telephone contact at 30-days after the procedure. RESULTS: A total of 1177 ERCPs were included in the analysis, of which 56.2% were therapeutic. The 30-day complication rate was 15.9%; the procedure-related mortality rate was 1.0%. Post-ERCP pancreatitis occurred in 3.8% of patients (3 deaths). Hemorrhage or perforation occurred with 0.9% and 1.1%, respectively, of the procedures (3 deaths). One perforation that resulted in the death of the patient occurred after placement of an endoprosthesis. Cholangitis occurred in relation to 5% of the ERCP procedures (3 deaths). Cardiorespiratory complications occurred in 2.3% (2 deaths). Dilated bile duct ( p = 0.0001), placement of stent ( p = 0.001), and use of more than 40 mg of hyoscine-N-butyl bromide ( p < 0.05) were risk factors for complications by multivariate analysis. Risk of pancreatitis was increased with age under 40 years ( p = 0.0078), placement of stent ( p = 0.031), and a dilated bile duct ( p = 0.036). CONCLUSIONS: This prospective study confirms that the complication rate of ERCP including therapeutic procedures is high. Cardiopulmonary complications were not as common as expected, despite being the special focus of the study.

Adolescent↗
PubMed2003

[Organization of the preoperative patient's course in ambulatory laparoscopic cholecystectomy].

INTRODUCTION: The aim was to describe the organisation of an out-patient clinic for patients with gallstone disease in a day-surgery department and to evaluate the collaboration between admitting doctors and the hospital concerning the preoperative course. MATERIAL AND METHODS: 101 patients who had gallstone disease were admitted consecutively to the out-patient clinic. Information provided by the admitting doctors regarding the history of the disease, the blood-samples and the ultrasound was registered. Information of the treatment was subsequently obtained from medical records. RESULTS: On the admission 15% had symptoms, in 28% there were results of the liver function-test and in 56% there were results of ultrasound on the liver, gallbladder and pancreas. 46 patients were direct scheduled for surgery without further investigation and eight patients were finished without any treatment. In total 65 patients were operated, 23 patients were finished without any treatment, five patients were further elucidated and in eight cases no decision were taken concerning treatment by the end of the study. DISCUSSION: It was possible to schedule surgery at the first consultation in only 50% of the patients admitted with gallstone disease. The reason was mostly missing information from the liver function test or the ultrasound examination of the liver and bile ducts. Collaboration between the general practitioners and the hospital is of importance to achieve a rational preoperative evaluation of patients admitted with gallstone disease.

Adult↗
PubMed2003

[Ventral herniotomy. Development of surgical technique and effect on the frequency of recurrence].

The surgical journal, Repair of Ventral Hernias, was reviewed with regard to recurrence of hernia. Ventral hernias must be operated on with a tension-free technique. It is recommended that hernias larger than 4 cm are repaired with mesh. A randomised, controlled trial has yet to be carried out to determine whether even small hernias should be repaired with mesh. Controlled and uncontrolled studies have shown that the use of mesh to repair larger hernias results in a lower recurrence rate. The operative technique with the mesh placed to bridge the wall defect gives a higher rate of recurrence than does an overlap technique. The overlap of the mesh and its placement in relation to the different layers of abdominal wall are not defined. The laparoscopic operation using the overlap technique and intraperitoneal mesh has shown a lower recurrence rate than the open technique. However, a randomised, controlled study comparing the laparoscopic and open overlap technique over a long follow-up period still needs to be conducted.

Hernia, Ventral↗
PubMed2002

[Assessment of the treatment of acute pancreatitis].

INTRODUCTION: The first international evidence-based guidelines for the management of acute pancreatitis were published in 1998. The aim of this study was to compare the care giving to patients with these guidelines. MATERIAL AND METHODS: During the period, June 1996 to May 1999, a survey was carried out of all patients with acute pancreatitis six months after discharge. RESULTS: One hundred and fifty-five patients with a first attack were identified within 48 hours (goal: 100%). Fifty (32%) had gallstones identified. Fifty-one (32%) were severe cases with ten (20%) deaths (goal: < 30%). The overall mortality (6.4%) was within the goal of less than 10%. Objective severity stratification (Ranson scoring) was performed in 94% (goal: 100%), and in severe cases 82% (goal: 100%) had a CT. In severe gallstone pancreatitis, 90% (goal: 100%) underwent an early ERCP (< 72 hours after admission). One management goal was not met: in mild cases, only 20-25% (goal: 100%) with gallstone pancreatitis were given definitive treatment within four weeks. DISCUSSION: The treatment we offer our patients with acute pancreatitis is optimal--apart from one standard--when compared with international guidelines, but in spite of this exception the mortality rate is low.

Acute Disease↗
PubMed2002

Factors that affect the variability in heart rate during endoscopic retrograde cholangiopancreatography.

OBJECTIVE: To find out if drugs, position, and endoscopic manipulation during endoscopic retrograde cholangiopancreatography (ERCP) influence the changes in the variability of heart rate. DESIGN: Single-blind randomised trial. SUBJECTS: 10 volunteers given butyscopolamine, glucagon, or saline intravenously on three different study days, and 10 patients who had ERCP without butylscopolamine or glucagon. MAIN OUTCOME MEASURES: Holter tape analysis for ischaemia and changes in the variability of heart rate. RESULTS: 5 volunteers developed tachycardia after butylscopolamine, while 2 developed tachycardia after glucagon. During ERCP 9 patients developed tachycardia, and 2 developed myocardial ischaemia. Vagal tone decreased in the volunteers after butylscopolamine, but no changes were seen after glucagon or placebo, or in patients during ERCP. CONCLUSIONS: Butylscopolamine reduced vagal tone in volunteers. Patients who were having ERCP without butylscopolamine had a stable vagal tone. The previously observed reduced vagal tone during ERCP may therefore be primarily the result of giving butylscopolamine.

Adult↗
PubMedDate not supplied

Objective assessment of gastrointestinal endoscopy skills using a virtual reality simulator.

BACKGROUND: This study was carried out to validate the role of virtual reality computer simulation as a method of assessment of psychomotor skills in gastrointestinal endoscopy. We aimed to investigate whether the GI Mentor II computer system (Simbionix Ltd.) was able to differentiate between subjects with different experience with GI endoscopy. METHODS: Twenty-eight subjects were included in the study. They were divided into 3 groups according to their experience with GI endoscopy: experienced [group 1, performed > 200 endoscopic procedures, (n = 8)] residents [group 2, performed < 50 endoscopic procedures, (n = 10)] and medical students [group 3, never performed GI endoscopy, (n = 10)]. All participants received identical pretest instruction on the simulator. Assessment of endoscopic skills was performed during a simulated colonoscopy and was based on parameters measured by the computer system: time, percentage of mucosa surface examined, efficiency of screening, time with a clear view, excessive local pressure, pain, time with pain, loop formation, and total time with a loop. RESULTS: Significant differences in performance existed between surgeons in the 3 groups. Experienced surgeons demonstrated best performance parameters, followed by the residents and the medical students. Significant differences in time (Kruskal-Wallis test, P < 0.001), percentage of mucosa surface examined (P = 0.001), efficiency of screening (P = 0.001), time with a clear view (P = 0.001), pain experienced (P = 0.004), time with pain (P = 0.012), loop formation (P < 0.001), time with a loop (P < 0.001), and excessive local pressure (P = 0.001) were demonstrated. Significant differences existed between group 1 and 2 and 1 and 3 (Mann-Whitney test, P < 0.05). Differences between groups 2 and 3 did not reach statistical significance (P > 0.05). CONCLUSIONS: The VR simulator was able to differentiate between subjects with different endoscopic experience. This indicates that the GI Mentor measures skills relevant for gastrointestinal endoscopy and can be used in training programs as an assessment tool.

Computer Simulation↗