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T Stefánsson

Publications and source records attributed to T Stefánsson.

15 recordsLinked to original sources
PubMed1997

Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy.

PURPOSE: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP) in diagnosing diverticulitis of the sigmoid colon. MATERIAL AND METHODS: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. RESULTS: Fifty-two patients were found to have sigmoid diverticulitis: 20 patients by laparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. CONCLUSION: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be ruled out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis.

Adult↗
PubMed1995

Laparoscopic suture rectopexy.

PURPOSE: This article describes a technique for laparoscopic suture rectopexy and assesses the postoperative results. METHODS: The rectum was fixed to the presacral fascia with five to six sutures. The procedure was performed using a laparoscope in four patients. RESULTS: There were no postoperative complications. In one patient a large enterocele was observed during the operation. This patient developed a recurrence about one month postoperatively. CONCLUSION: Laparoscopic suture rectopexy might be an alternative to open rectopexy for patients with isolated rectal prolapse.

Adult↗
PubMed1995

Cancers among patients diagnosed as having diverticular disease of the colon.

OBJECTIVE: To assess the incidence of underlying malignancy in patients with a diagnosis of diverticular disease of the colon. DESIGN: Retrospective cohort study. SETTING: University hospital, Sweden. SUBJECTS: 7159 patients discharged from hospital with a first diagnosis of diverticulosis or diverticulitis in central Sweden 1965-1983. INTERVENTION: The cohort was followed up for two years for the occurrence of cancer. MAIN OUTCOME MEASURE: Cancer incidence. RESULTS: A total of 372 cancer cases were identified standard incidence ratio = 2.4; 95% confidence interval 2.2 to 2.7). Sites at excess risk during the first year were: colon and rectum, pancreas, prostate, stomach, lymphatic and haemopoietic tissue, liver and bile ducts, ovary and lung, with the highest excess risk in the left colon (standard incidence ratio = 17.8; 95% CI 12.7 to 24.1). CONCLUSION: Malignant diseases, especially colorectal cancer, are relatively common among patients with a clinical diagnosis of diverticulosis or diverticulitis of the colon. This may indicate a need for a change in current clinical practice.

Aged↗
PubMed1994

Accuracy of double contrast barium enema and sigmoideoscopy in the detection of polyps in patients with diverticulosis.

The sensitivity between double contrast barium enema (DCBE) and sigmoideoscopy in diagnosing neoplastic lesions in the sigmoid colon was compared in patients with diverticulosis. In 52 patients with severe diverticulosis (> or = 15 diverticulas) the DCBE detected one out of 4 polyps found by sigmoideoscopy. In the remaining 54 patients with mild diverticulosis (< 15 diverticulas) DCBE detected 7 out of 10 polyps found by sigmoideoscopy. Successful bowel preparation did not influence the outcome of the DCBE. Sigmoideoscopy was incomplete in 17 (16%) of the patients; females were more difficult to examine than males (p = 0.012), as were those with a previous pelvic operation (p = 0.032). We conclude that neither DCBE nor sigmoideoscopy alone is sufficient to detect all neoplastic lesions in the sigmoid colon in patients with sigmoid diverticulosis of the colon.

Adult↗
PubMed1993

Prolonged total extracorporeal lung assistance without systemic heparinization.

A 16-year-old female developed severe ARDS in her single remaining lung following pneumonectomy for blunt trauma. Total extracorporeal lung assist (ECLA) for 40 days using a covalently heparin-coated circuit proved lifesaving. Systemic heparinization was not applied, as the heparinized surface by itself prevented clotting of the extracorporeal circuit. Systemic primary fibrinolysis developed but was not associated with major bleeding. A veno-right ventricular cannulation technique was used and maximum venous drainage for the extracorporeal circulation was achieved by elevating the bed 50 cm from the floor. This allowed extracorporeal blood flow (ECBF) approaching cardiac output (CO) and complete extracorporeal replacement of lung function. After 40 days, lung recovery allowed discontinuation of ECLA. Five days later the patient suffered serious lung collapse and was operated for a bronchopleural fistula. The patient was extubated 4 weeks after terminating ECLA and discharged in good condition 5 weeks later.

Adolescent↗
PubMed1993

Increased risk of left sided colon cancer in patients with diverticular disease.

Certain similar epidemiological characteristics suggest a common aetiology for colon cancer and diverticulosis of the colon. The hypothesis that patients with diverticulosis are at increased risk of developing colon cancer was tested in a retrospective, population based, cohort study in Sweden. A total of 7159 patients (2478 men and 4681 women) who had been given a hospital discharge diagnosis of diverticulosis or diverticulitis of the colon between 1965 and 1983 were followed up during 1985 by means of record linkage procedures. After excluding the first 2 years of follow up, there was not a significant increase in risk (SIR) overall for colon cancer (SIR = 1.2; 95% confidence intervals (CI) 0.9, 1.6) or for rectal cancer (SIR = 1.1; 95% CI 0.7, 1.7). The observed number of right sided colon cancers was as expected (SIR = 0.9; 95% CI 0.5, 1.5). In contrast, an increased risk of left sided colon cancer was found both overall (SIR = 1.8; 95% CI 1.1, 2.7) and consistently in men and women as well as in different age groups. This risk increased the longer the follow up (p value for trend < 0.001). These results do not support the hypothesis of a common aetiology in diverticular disease and colonic cancer but suggest a causal relationship between diverticular disease and cancer of the left colon.

Adult↗
PubMed1984

Material thrombogenicity in central venous catheterization III. A comparison between soft polyvinylchloride and soft polyurethane elastomer, long, antebrachial catheters.

Soft venous catheters, 36 made of polyurethane (PU) and 37 made of polyvinylchloride (PVC), were inserted in 73 patients via basilic and cephalic veins punctured at the cubital fossa, and compared regarding their thrombogenicity. The mean duration of catheterization was 12.5 days. Two patients with PU- and six patients with PVC-catheters developed clinical thrombophlebitis 4-36 days after insertion. The radiological thrombi were rather small with both PU- and PVC-catheters in both peripheral and central veins with no significant difference between the catheters. Also, the incidence of thrombosis and the rate of catheter occlusions were similar. The surface topography of the PVC-catheters was relatively smoother, but less uniform than that of the PU-catheters. Platelet adhesion in vitro to the catheter surfaces, expressed as ATP-concentration in relation to catheter area after contact with human blood, was relatively low with both catheters. The results suggest that soft PU- and PVC-catheters have a similar thrombogenicity.

Adolescent↗
PubMed1984

Dynamics of thrombophlebitis in central venous catheterization via basilic and cephalic veins.

The incidence distribution of thrombophlebitis after central catheterization via basilic and cephalic veins was investigated, using 227 catheters made of various plain or heparin-coated materials and with differing stiffness and surface structures. The platelet-adhesion stimulating properties were measured in vitro. Thrombophlebitis showed similar incidence patterns with all catheter types. The maximum incidence of venous reaction was found one to ten days after catheter insertion (central tendency 3-8 days with a peak at 5 days). After ten days the risk of thrombophlebitis fell significantly. The results supported the view that central venous catheters inserted via basilic or cephalic veins should not be withdrawn or exchanged as prophylaxis against thrombophlebitis, at any rate when long-term catheterization is intended. For conclusive comparisons between catheter materials regarding induction of clinically apparent thrombophlebitis, all the patients in the trial should be catheterized for ten days or more, unless symptoms of venous reaction arise earlier.

Adolescent↗
PubMed1982

Hemodynamic and metabolic effects of ketamine anesthesia in the geriatric patient.

The cardiovascular and metabolic effects of ketamine as the sole anesthetic agent for surgical correction of fractured neck of femur were studied in eight spontaneously breathing geriatric patients (mean age 83 years) before premedication, at the end of operation, and 15 min and 2 h after the end of anesthesia. Arterial blood pressure, cardiac index, left ventricular stroke work index and oxygen consumption increased during anesthesia but had returned to preoperative levels 15 min after the end of anesthesia. Vascular resistance, heart rate and stroke volume index were not significantly changed. During anesthesia, arterial carbon dioxide tension increased whereas arterial pH and arterial BE decreased. The levels of glucose and lactate increased in both blood and skeletal muscle during anesthesia and remained elevated throughout the period studied but the lactate:pyruvate ratio was unchanged. High energy phosphagen levels in skeletal muscle did not change. Ketamine anesthesia in the spontaneously breathing geriatric patient induces cardiovascular stimulation and metabolic changes indicative of an increased sympathetic stimulation, whereas respiration is slightly depressed. The magnitude of these changes is, however, small and it thus seems that ketamine can be safely used as the sole anesthetic agent for hip fracture surgery in the average geriatric patient.

Aged↗
PubMed1982

Survival of female geriatric patients after hip fracture surgery. A comparison of 5 anesthetic methods.

Female geriatric patients (mean age 80.9 years; n = 169) undergoing surgery for hip fracture were given epidural, neurolept analgesia, ketamine, enflurane or halothane anesthesia. The rate of survival in the different groups was studied up to 4 years after the operation and compared with the expected survival of normal groups of women with the same age distribution. Mortality at 1 month (6.5%) was equally distributed between the anesthetic methods and was not correlated to age or the type of fracture. The preoperative condition of the patient seemed to be the most important factor for survival. At 6 months, the rate of mortality was 17.2%. Together with age, the type of fracture was the most important determinant for survival. Differences in late survival between the groups were recorded, but the clinical significance of these differences is uncertain since many factors other than the anesthetic method may be more important.

Aged↗