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T Lindhagen

Publications and source records attributed to T Lindhagen.

At least 19 recordsLinked to original sources
PubMed1999

Complications of laparoscopy-aided gastrostomies in pediatric practice.

PURPOSE: The aim of this report is to establish the frequency and type of complications of laparoscopy-aided gastrostomy in pediatric practice and to identify patients at risk for postoperative complications. METHOD: This is a follow-up study of 98 children with nutritional problems including inability to swallow, inadequate calorie intake in neurologically impaired children, patients with cystic fibrosis, malignancies, neurometabolic diseases, and cardiac malformations. Laparoscopy-aided gastrostomy was attempted in all patients. These patients have undergone follow-up at our outpatient clinic. Postoperative complications and problems with the gastrostomy device were registered. The postoperative complications were divided into minor problems and major or life-threatening complications. RESULTS: There was no perioperative mortality. No life-threatening complication developed, whereas minor problems were common, necessitating medical attention postoperatively. Patients with congenital heart disease, chronic respiratory failure, and metabolic diseases experienced the highest frequency of postoperative complications. CONCLUSIONS: The surgical placement of an enteral access device in children should be considered a major surgical procedure, demanding medical attention for 1 to 2 months postoperatively. The rate and severity of complications with the method described are tolerable considering the severity of the underlying diseases.

Child↗
PubMed1999

Routine laparoscopy for nonpalpable testes?

There are still no accepted criteria for the selection of patients with nonpalpable testes for laparoscopy versus a primary surgical exploration. We here report our experience using routine laparoscopy in such patients. The aim was to determine whether laparoscopy should be the first operative intervention or follow an inguinal exploration. Included in the study were 61 boys with 69 nonpalpable testes. Thirty-three testes were found in the abdomen, and 36 testes were extra-abdominal or nonexistent. If an exploration of the inguinal region had been the initial surgical intervention, six testes would have been found, making laparoscopy unnecessary. On the other hand, in the search for 63 missing testes, laparoscopy saved the patients from laparotomy or an extensive inguinal exploration. We conclude that an accurate knowledge of testis, vas, and vessel location gained by laparoscopy facilitates the selection of an appropriate surgical strategy, saving at least 51% of patients from laparotomy or an extensive inguinal exploration.

Adolescent↗
PubMed1999

Power Doppler ultrasonography: alternative to computed tomography in abdominal trauma patients.

The aim of this study was to determine if power Doppler ultrasonography, contrast enhanced when necessary, can be used as an alternative to computed tomography in the diagnosis of trauma-related organ rupture or hematoma. Fifteen patients who had sustained abdominal trauma but who had normal results on B-mode scans were included in the study. Twenty organs (13 livers and 7 spleens) were examined with both contrast-enhanced computed tomography and power Doppler ultrasonography in a blinded fashion. Ultrasonographic contrast was used in five patients. Lack of contrast enhancement (computed tomography) or lack of color in power color Doppler ultrasonography in all or part of the organ was taken as a sign of rupture or hematoma. Five ruptures were detected with both modalities (two hepatic and three splenic). Thus, ultrasonography showed no false-positive or false-negative studies when compared to the computed tomographic results. No significant difference was found in the estimated size of the damaged area between the two types of investigation. The study indicates that power color Doppler ultrasonography may be considered an alternative when a computed tomographic scan of a trauma patient is impossible.

Abdomen↗
PubMed1996

Laparoscopy for nonpalpable testis in childhood: is inguinal exploration necessary when vas and vessels are not seen?

A case of bilateral nonpalpable testes is described. Ultrasonography showed no testis. Laparoscopy revealed no intraabdominal testis, vas or vessels. Human chorionic gonadotrophine test suggested the presence of testicular tissue. Computed tomography showed a testis present in each inguinal canal. Inguinal exploration confirmed the finding. This case stresses the importance of careful interpretation of the laparoscopic findings together with other diagnostic methods in localizing testicular tissue in patients with nonpalpable testes.

Child↗
PubMed1996

Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin.

OBJECTIVE: To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin. DESIGN: Prospective, randomised, double-blind study. SETTING: University hospital, Sweden. SUBJECTS: 30 Boys randomised to be treated with clobetasol propionate (n = 15) or placebo (n = 15). INTERVENTIONS: The boys were examined 1, 2 and 6 months, respectively, after treatment. MAIN OUTCOME MEASURES: Comparison between the effects of clobetasol propionate and placebo. RESULTS: Two patients in the steroid group and one in the placebo group withdrew from the study. 10 Boys in the steroid group showed an improvement within 2 months. The remaining 3 boys had no effect and were circumcised. Histopathological examination showed lichen sclerosus et atrophicus. Seven boys in the placebo group improved. The 7 non-responders were prescribed clobetasol propionate ointment, and all 7 improved. CONCLUSION: 17 of 27 boys referred with "phimosis" were successfully treated with an ointment and gentle traction. When clobetasol propionate was given the non-responders success rate was increased to 24/27 (89%).

Administration, Topical↗
PubMed1995

Low prevalence of anti-neutrophil cytoplasmic antibodies in ulcerative colitis patients with long-term remission.

OBJECTIVES: In spite of a strong positive association between ulcerative colitis and the presence of perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCAs), the immunogenetic significance of these antibodies remains unclear. We studied patients with quiescent disease to clarify whether ANCAs are present even in the absence of inflammation. DESIGN: The prevalence of ANCAs was estimated blindly in 137 patients with ulcerative colitis, 128 of whom had quiescent disease with a mean duration of complete clinical and biochemical remission of 14 years. For comparison, we studied sera from 110 patients with Crohn's disease, 27 of whom had a low or intermediate grade of inflammatory activity. The mean duration of complete remission in these patients was 8.5 years. METHODS: ANCAs were detected using indirect immunofluorescence and enzyme-linked immunosorbent assays (ELISAs). RESULTS: Only 13 (9%) of 137 patients with ulcerative colitis had ANCAs (5% had p-ANCAs). Three patients had previously undergone colectomy. In patients with Crohn's disease, ANCAs were observed in 17 of 110 patients (15%, 6% had p-ANCAs). Fifteen of these patients had colonic disease. CONCLUSION: In patients with ulcerative colitis free from inflammation for prolonged periods of time, ANCAs occurred less frequently than has previously been reported. Patients with Crohn's disease had the expected frequency of ANCA positivity, which for colonic Crohn's disease was comparable to that found in patients with ulcerative colitis. These findings suggest that the titre of ANCAs decreases with time in inactive disease and may be undetectable with conventional assays after several years of complete remission.

Adult↗
PubMed1993

HLA DR and DQ RFLP analysis in Crohn's disease.

A study of 109 Swedish patients and 85 healthy Swedish controls with Crohn's disease (CD) by HLA class II RFLP genotyping was carried out. There was no significant association for any single DR or DQ specificity or phenotypic combination of DR and/or DQ specificities among our study group of Caucasian extraction.

Base Sequence↗
PubMed1988

Inguinal hernia in patients with congenital dislocation of the hip. A sign of general connective tissue disorder.

During a 5-year period, all the children born in Malmö, Sweden, were examined for congenital dislocation of the hip (CDH) and for inguinal hernia. Girls with CDH had a hernia five times more frequently than other girls, and boys with CDH three times more frequently. The children with CDH sustained their hernia abnormally early in life. We suggest that relaxin, which stimulates collagenase, could alter the connective tissue and be of importance for the development of both CDH and the hernia.

Child, Preschool↗
PubMed1987

Surgical treatment of inflammatory bowel disease--a review of some current opinions and controversies.

There are many controversial issues regarding the treatment of patients with inflammatory bowel disease. From this review we have concluded that the longer surgery for Crohn's disease is delayed, the higher the rate is of pre- and postoperative complications. A plea is thus made for relatively early surgical intervention. For Crohn's disease, the general policy today is to perform resections, even if relatively limited ones, rather than to perform by-passes of the macroscopically involved intestine. Indeterminate colitis, as well as self-limiting colitis, are differential diagnoses that the surgeon must be aware of, especially when selecting the appropriate operative method. Due to the existent risk of cancer in ulcerative colitis, some authors advocate prophylactic colectomy after 10 to 15 years, but the most current policy seems to be one of close surveillance, with surgery only in the cases of severe dysplasia or if a so called dysplasia associated lesion or mass (DALM) is diagnosed. Coloproctectomy has been the standard procedure for patients with ulcerative colitis, however, good or even excellent results are often seen after ileorectal anastomosis and pelvic pouch operations. Although all patients cannot benefit from the latter operation it is likely that it will become the principal operation for patients with ulcerative colitis.

Colectomy↗
PubMed1986

Fertility and outcome of pregnancy in patients operated on for Crohn's disease.

Fertility and outcome of pregnancy were assessed in all 78 women below 40 years of age in a total, unselected series of patients with Crohn's disease, diagnosed during a 17-year period and consecutively treated with resectional surgery, in most cases at an early stage. The median follow-up time after the primary operation was 12.8 years. During the observation time there were 87 pregnancies in 44 patients. Neither the number of live births, nor the frequency of abortions differed from that expected in the general population. There was no still birth. The localization of the disease was not significant. In conclusion, there were no indications of any negative influence of surgical intervention.

Abortion, Spontaneous↗
PubMed1984

Are superficial lesions of the distal part of the ileum early indicators of Crohn's disease in adult patients with abdominal pain? A clinical and radiologic long term investigation.

The possibility of early superficial Crohn's disease should be considered when mucosal irregularities without transmural abnormalities are seen in the distal 15 cm of the ileum in young patients with protracted symptoms of abdominal pain and diarrhoea. Radiologic assessment of the small bowel is improved using the barium/air double contrast technique and in this study mucosal abnormalities were categorised as a 'mucosal nodularity pattern', an 'abnormal mucosal fold pattern', and a 'specks of barium pattern'. None of the 21 patients followed prospectively for four to seven years developed established criteria for Crohn's disease, or any other chronic progressive disease of the small bowel. Colon examinations were normal. In comparison 26 patients with histologically proven Crohn's disease of the ileum were studied retrospectively and no similar clinical or radiologic characteristics were present. It is concluded, therefore, that such isolated superficial lesions are not pathognomonic and are not early indicators of Crohn's disease or any other chronic progressive disease of the small bowel.

Abdomen↗
PubMed1984

Pre- and post-operative complications in Crohn's disease with special reference to duration of preoperative disease history.

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohn's disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohn's disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohn's disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.

Crohn Disease↗
PubMed1983

Occult bleeding from giant small-bowel diverticula.

Two cases of occult intestinal blood loss due to giant ileal diverticula are described. In one of them, ectopic gastric mucosa was found at microscopic dissection. In the other that was probably originating from a blind loop formation at a previous operation, multiple mucosal erosions, probably due to retained bowel contents, were considered responsible for the blood loss. Though giant diverticula are rare throughout the gastrointestinal tract, and usually cause symptoms other than bleeding, the importance of a careful search for this malformation in children with occult faecal blood loss is stressed.

Adolescent↗
PubMed1983

Recurrence rate after surgical treatment of Crohn's disease.

In an unselected series of 207 consecutive patients with Crohn's disease diagnosed between 1958 and 1974, 170 underwent a resection of all the macroscopically involved bowel ('radically' resected). Two patients died during the first postoperative month. The crude recurrence rate for the surviving 168 patients was 49%. The cumulative recurrence rate, calculated by the actuarial method, was 53% at 15 years. Age, sex, length of preoperative disease history, localization of the lesions in the bowel, and primary surgical procedures performed had no influence on the recurrence rate. However, the histopathological appearance of the resection margins seemed to influence the prognosis, since the presence of ulcers and/or granulomas was correlated with a significantly increased recurrence rate.

Actuarial Analysis↗
PubMed1983

Crohn's disease in a defined population course and results of surgical treatment. I. Small bowel disease.

In a total, unselected series of 207 patients with Crohn's disease diagnosed between 1958 and 1974, 87 of the 182 patients operated upon during the investigated period were, at a comprehensive reevaluation, found to have the disease predominantly or exclusively confined to the small bowel. In five of these cases wide-spread lesions were present. The frequency of preoperative sequelae or complications was low. Postoperative complications were comparatively few with only one death. The calculated recurrence rate at 15 years was 43%. In spite of the fact that some patients needed repeated resections, the outcome of surgery as assessed at the end of the observation time was good in most cases.

Adolescent↗
PubMed1983

Crohn's disease in a defined population course and results of surgical treatment. Part II. Large bowel disease.

In a total consecutive series of 182 patients operated upon for Crohn's disease, 95 (52%) had the lesions predominantly or exclusively confined to the colon. A "radical" operation was performed in 88 of these 95 patients. The general policy was to spare the rectum, if possible. It was found that when the rectum was primarily involved the lesions did not disappear after subtotal colectomy. Ileorectal anastomosis was only successful in 9 of 22 cases. In all these nine cases the rectum was uninvolved preoperatively. The overall mortality rate related to Crohn's disease was 6% and the overall recurrence rate 62%. All patients with an anastomosis between a disease-free small intestine and a diseased colon developed recurrence in the ileum. Therefore, a thorough preoperative examination of the whole colon is essential.

Adolescent↗