PubMed Health⌕ Search

Biomedical subjects

T Zilling

Publications and source records attributed to T Zilling.

At least 19 recordsLinked to original sources
PubMed2003

Heller's esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study.

Heller's esophagomyotomy relieves dysphagia but does not restore esophageal peristalsis. The myotomy may induce reflux and the addition of a 360 degrees fundoplication may be hazardous with regard to the remaining aperistaltic esophagus. The aim of this prospectively randomized clinical trial was to compare the outcome for patients with uncomplicated achalasia who underwent an anterior Heller's esophagomyotomy (H group) with or without an additional floppy Nissen fundoplication (H + N group). Between 1984 and 1995, 20 patients were prospectively randomized to one or other of the performed operations, 10 patients per group. Esophagitis including Barrett's esophagus (n = 2) was seen under medical treatment, in 6 of 9 in the H group but none in the H + N group. No patient in the H + N group required postoperative continuous acid-reducing drugs. Twenty-four-hour esophageal pH-studies in median 3.4 years after surgery showed pathological reflux expressed as a percentage of time below pH 4 of 13.1% in the H group compared to 0.15% (P < 0.001) in H + N group. One patient with recurrent dysphagia in the H + N group later had an esophagectomy. The remaining patients reported significant improvement of dysphagia without symptoms of reflux at 8.0 years follow-up. Heller's esophagomyotomy eliminates dysphagia, but can induce advanced reflux that requires medical treatment. The addition of a 360 degrees fundoplication eliminates reflux without adding dysphagia in the majority of patients and can be recommended for most patients with uncomplicated achalasia.

Adult↗
PubMed2001

Increasing prevalence of adenocarcinoma of the oesophagus and gastro-oesophageal junction: a study of the Swedish population between 1970 and 1997.

OBJECTIVE: To see whether there was an increasing incidence of adenocarcinoma of the oesophagus and gastric cardia in the Swedish population. If there is a rising trend and variations in it can be found, could it be explained as a period or cohort phenomenon? The data were also compared with the incidence of squamous cell carcinoma and gastric cancer with the gastric cardia excluded. DESIGN: Retrospective study. SETTING: Sweden. SUBJECTS: Swedish population. MAIN OUTCOME MEASURES: Age standardised incidence for each sex was calculated using the age distribution of the world population as a reference. Age-period-cohort models were fitted to data using Poisson regression to model log incidence rates. RESULTS: For the combined group of adenocarcinoma in the oesophagus and gastric cardia age standardised incidence gradually increased during the study period. The median increase between adjacent five-year intervals was 20% in women and 14% in men. A period effect was evident in men. CONCLUSION: This study shows that the incidence of adenocarcinoma of the oesophagus and gastroesophageal junction is rising for both men and women in the Swedish population. This is explained as a period effect. As well as previously-described risk factors such as gastro-oesophageal reflux, obesity, and smoking, the increasing incidence can be explained as a shift in classification from squamous cell carcinoma to adenocarcinoma after 1985.

Adenocarcinoma↗
PubMed2001

Endoscopic surveillance of columnar-lined esophagus: frequency of intestinal metaplasia detection and impact of antireflux surgery.

OBJECTIVE: To quantify the occurrence of intestinal metaplasia in columnar-lined esophagus (CLE) during endoscopic surveillance and to evaluate the impact of antireflux surgery on the development of intestinal metaplasia. SUMMARY BACKGROUND DATA: The malignant potential in segments of CLE is mainly restricted to those containing intestinal metaplasia. Patients with segments of CLE in which no intestinal metaplasia can be detected are rarely enrolled in a surveillance program but may still be at increased risk of developing esophageal adenocarcinoma because intestinal metaplasia may be missed or may develop with time. METHODS: The occurrence of intestinal metaplasia on biopsy samples was determined on repeated endoscopies in 177 patients enrolled in a surveillance program for CLE. The incidence of intestinal metaplasia in patients with no evidence of intestinal metaplasia on the two first endoscopies was evaluated on the subsequent endoscopies and compared in patients with medically and surgically treated gastroesophageal reflux disease. RESULTS: Intestinal metaplasia was found in 53% of the patients (94/177) on their first surveillance endoscopy and was more prevalent in long segments of CLE. The prevalence of intestinal metaplasia increased markedly with increasing number of surveillance endoscopies. Intestinal metaplasia tended to be detected early in patients with long segments of CLE; in patients with shorter segments, intestinal metaplasia was also detected late in the course of endoscopic surveillance. Patients with surgically treated reflux disease were 10.3 times less likely to develop intestinal metaplasia compared with a group receiving standard medical therapy. CONCLUSION: Biopsy samples from a single endoscopy, despite an adequate biopsy protocol, are insufficient to rule out the presence of intestinal metaplasia. Patients in whom biopsy specimens from a segment of CLE show no intestinal metaplasia have a significant risk of having undetected intestinal metaplasia or of developing intestinal metaplasia with time. Sampling error is probably the reason for the absence of intestinal metaplasia in segments of CLE longer than 4 cm, whereas development of intestinal metaplasia is common in patients with shorter segments of CLE. Antireflux surgery protects against the development of intestinal metaplasia, possibly by better control of reflux of gastric contents.

Aged↗
PubMed2000

Anastomotic diameters and strictures following esophagectomy and total gastrectomy in 256 patients.

The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n = 107) or total gastrectomy and Roux reconstruction (n = 149). No perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p = 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p = 0.176) nor that in the gastrectomy group (abdomen or chest) (p = 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.

Adult↗
PubMed2000

Pre- and postoperative information needs.

The purpose of this study was to investigate patients' need for pre- and postoperative information. Fifty patients admitted to open cholecystectomy were included in the study, 37 women and 13 men. Their median age was 49.5 years, ranging 17-76. The patients answered one questionnaire both at admission and at discharge. In the questionnaire, 48 statements had to be answered on a five-point, Likert scale. Our data show that patients admitted for cholecystectomy want a lot of information both at admission and at discharge. The most requested information was related to anxiety-creating factors such as pain and post-operative symptoms after surgery. Thirty per cent of the patients wanted both written and verbal information. This result focuses on the need to develop and share with the patient both written and verbal information.

Adolescent↗
PubMed1999

Gastrostomy by various techniques: evaluation of indications, outcome, and complications.

BACKGROUND: Gastrostomy can be performed with a percutaneous fluoroscopic technique, a percutaneous endoscopic technique, or open surgery. Since all three methods are in use at our hospital, we made this retrospective study to compare indications, complications, and outcomes for the different techniques. METHODS AND RESULTS: During the period January 1990 to December 1994, 147 patients admitted to Lund University Hospital required gastrostomy. The records of these patients were retrospectively studied. Six patient records could not be found, and these patients were therefore excluded. Of the remaining 141 patients, 94 had undergone fluoroscopic percutaneous gastrostomy, 12 percutaneous endoscopic gastrostomy (PEG), and 35 gastrostomy at open surgery. The 30-day overall mortality was 15% in the fluoroscopy group, 17% in the endoscopy group, and 29% in the open surgery group. The 30-day mortality as related to the procedure was 3.2% in the fluoroscopy group, 0% in the PEG group, and 2.9% among the patients with open surgery. The morbidity related to the procedure was 16%, 8%, and 20%, respectively. For the 30-day overall mortality and for the procedure-related mortality there was no statistically significant difference between the groups (P = 0.2019, P = 0.8215). For the percutaneous procedures the indication was nutrition in most patients. For the patients receiving gastrostomy at open surgery drainage was the main indication. Even though the complication rate was higher in this group, most complications were minor, and there was only one procedure-related death. Gastrostomy at open surgery is often performed in severely ill patients. Despite this, it does not seem to cause more complications than the percutaneous techniques in our study. CONCLUSION: The study shows that gastrostomies are safe procedures, with few complications and a low procedure-related mortality independent of the technique being used.

Adult↗
PubMed1999

Surgical approach and prognostic factors after peptic ulcer perforation.

OBJECTIVE: To find out which prognostic factors were important in predicting postoperative mortality and length of hospital stay in patients with perforated peptic ulcers. DESIGN: Retrospective study. SETTING: Teaching hospital, Lund, Sweden. SUBJECTS: 246 patients with perforated peptic ulcer who presented between January 1974 and December 1992. INTERVENTION: Cox proportional hazards analysis. MAIN OUTCOME MEASURES: Influence of age, sex, coexisting disease, duration of symptoms, site of perforation and operative technique on mortality and length of hospital stay. RESULTS: Age over 75 years (p = 0.002), coexisting cardiac or pulmonary disease (p = 0.02), perforation of the cardia or body of the stomach (p = 0.02), lapse of more than 12 hours between start of symptoms and operation (p = 0.006) and type of operation (p < 0.0001) had a significant influence on hospital mortality. Age over 75 years (p < 0.0001) and lapse of more than 12 hours between start of symptoms and operation (p = 0.03) significant influenced the likelihood of a prolonged stay in hospital. CONCLUSION: Patients with perforated peptic ulcers should be operated on as soon as possible. Simple closure is simple and safe with relatively low mortality and short stay in hospital.

Duodenal Ulcer↗
PubMed1998

Active or passive chest drainage after oesophagectomy in 101 patients: a prospective randomized study.

BACKGROUND: This study evaluates the efficiency and safety of two methods of chest drainage after uncomplicated oesophagectomy. METHODS: A prospective randomized study between active suction drainage and passive chest drainage was carried out in 101 patients who underwent gastric pull-up oesophagectomy. RESULTS: No difference in the prevalence of pneumothorax during treatment was noted between the active (nine of 55) and the passive (four of 46) drainage groups (P=0.20). Nor was there any difference in the size (P=0.46) and duration (P=0.53) of the pneumothorax. There was no significant difference in right (P=0.84) and left (P=0.61) basal atelectases and the amounts of right (P=0.10) and left (P=0.24) pleural effusions. There were significantly more basal atelectases (P < 0.001) and pleural effusions (P<0.001) in the non-operated left side compared with the operated right side. Postoperative hospital stay was the same in both groups (median 13 days; P=0.86). The hospital mortality rate was two of 101, and was not affected by the type of drainage. CONCLUSION: Passive drainage did not reduce hospital stay, but was as safe and effective as the active system in draining the pleural cavity after uncomplicated oesophagectomy.

Anastomosis, Surgical↗
PubMed1998

Nutritional state, growth rate, and morphology after total gastrectomy with restoration of duodenal passage or Roux-en-Y oesophagojejunostomy with or without a pouch: an experimental study in pigs.

OBJECTIVE: To compare the effect of restoration of duodenal continuity by a Roux-en-Y oesophagojejunostomy with or without a pouch on nutritional state, growth, and morphology after total gastrectomy in pigs. DESIGN: Experimental study. SETTING: Teaching hospital, Sweden. MATERIAL: 60 Swedish domestic pigs. INTERVENTIONS: 54 pigs underwent total gastrectomy and 6 had sham operations. 20 pigs had reconstruction by a Roux-en-Y oesophagojejunostomy, 21 had a jejunal loop interposed between the oesophagus and the duodenum, as 13 had a oesophagojejunostomy with jejunal pouch on a Roux-en-Y loop. MAIN OUTCOME MEASURES: Weight, laboratory indicators of nutritional state, and histological appearance of the gut. RESULTS: Growth was significantly retarded in those pigs that had had gastrectomies (p < 0.001) but there were no differences among the experimental groups. Haemoglobin, albumin, and calcium concentrations were significantly lower in the experimental groups than in the control group (p=0.006, 0.02, and 0.002, respectively). Histological examination showed subtotal villous atrophy in the experimental groups, most obvious in the pouch group. Colonic mucosal height was reduced in the experimental groups. CONCLUSION: This study failed to show any advantage in growth rate when restoration of duodenal continuity or a small bowel pouch were compared with a conventional Roux-en-Y oesophagojejunostomy after total gastrectomy. However, restored duodenal passage seemed to benefit calcium homeostasis.

Anastomosis, Roux-en-Y↗
PubMed1997

Peptic ulcer perforation before and after the introduction of H2-receptor blockers and proton pump inhibitors.

BACKGROUND: The aim of this retrospective study was to compare patients treated for perforated peptic ulcer before and after the introduction of the H2-receptor antagonists and proton pump inhibitors (PPI) with regard to their medical history, clinical features, methods of diagnosis and treatment, complications, and mortality. METHODS AND RESULTS: During the study period 1974 to 1992 we found a significant reduction in the incidence of peptic ulcer perforation (P < 0.001). Patients admitted during the later period of the study were older and more seriously ill. The incidence of perforation among men decreased, but that among women was stable, thus changing the sex ratio towards a female preponderance at the end of the study period. After the introduction of PPI the relative number of gastric perforations decreased compared with the number of perforations in the duodenum. A relatively higher proportion of patients with gastric perforations was taking acetylsalicylic acid or non-steroid, anti-inflammatory drugs at the time of admission compared with patients with duodenal perforation. Simple suture of the perforation was the operative procedure used in 80% of the patients. CONCLUSIONS: Even though patients were increasingly older and more ill, neither the mortality nor the rate of postoperative complications changed during the study period.

Age Factors↗
PubMed1996

Adenocarcinoma in the distal esophagus with and without Barrett esophagus. Differences in symptoms and survival rates.

OBJECTIVE: To evaluate differences in clinical appearance and survival rates in patients operated on for adenocarcinoma in the distal esophagus with and without Barrett epithelium. DESIGN: Prospective clinical study. SETTING: University hospital, Sweden. PATIENTS: Fifty-four patients with adenocarcinoma in the distal esophagus with (n = 17) or without (n = 37) Barrett epithelium. INTERVENTION: Esophagectomy or total gastrectomy. MAIN OUTCOME MEASURES: Preoperative symptoms, endoscopic results, and histological findings; postoperative morbidity, mortality, and survival rates. RESULTS: The main indication for the endoscopic examination that revealed tumor in the group with Barrett esophagus was reflex-related symptoms in 6 patients (routine Barrett examination, n = 4; symptoms of reflux, n = 2), symptoms related to upper gastrointestinal tract bleeding in 6, and malignant symptoms in 5 (dysphagia, n = 4; weight loss, n = 1). In contrast, most patients in the cardia cancer group were admitted because of malignant symptoms (dysphagia, n = 26; epigastric pain, n = 9; and anemia, n = 2). Ten of 17 patients in the Barrett esophagus cancer group had tumors limited to the mucosa and submucosa only. In 1 patient the tumor grew into the muscular layer but not through it. In the remaining 6 patients the tumor did grow through the muscular layer and lymph node metastases were found. Wall penetration was found in 30 patients and metastases to lymph nodes in 29 patients in the cardia cancer group. The hospital mortality rate was 0 of 17 patients in the Barrett cancer group and 2 of 37 patients in the cardia cancer group. In the patients operated on for adenocarcinoma in the distal esophagus, a better long-term survival rate was seen in those with Barrett epithelium (50%) than in those without this metaplasia (10%) (log rank P = .005; X2 = 7.80). CONCLUSIONS: Concomitant Barrett epithelium improved the prognosis for patients with adenocarcinoma in the distal esophagus. Probably the reason for this was a higher rate of early-stage disease, because symptoms of gastroesophageal reflux and other benign disorders, not dysphagia, were most common in patients with adenocarcinoma without Barrett epithelium in the distal esophagus.

Adenocarcinoma↗
PubMed1996

Surgicel reinforced resection lines in left-sided hepatectomy with linear stapling device. An experimental study on pigs.

Fourteen pigs underwent left-sided hepatectomy. The resection was performed with a linear stapling device and the pigs were randomised to either Surgicel reinforced resection lines or not. The median time required for resection was 25 min (range 17-30) in the Surgicel reinforced group compared to 30 min (range 21-41) in the stapled group. This difference was, however, not statistically significant (p = 0.053). The postoperative haemoglobin value was lower in the stapled group compared to the Surgicel reinforced group 69 g/l (range 42-85) versus 82 g/l (range 78-90) (p = 0.018). The estimated blood losses by weighing the compresses were 287 ml (range 166-379) for the stapled group and 204 ml (range 152-264) for the Surgicel reinforced group (p = 0.053). The median number of additional haemostatic sutures in the Surgicel reinforced group was 7 (range 3-11) and in the stapled group 10 (range 5-15) (p = 0.038). The haemoglobin value was similar in the two groups 1 week postoperatively; 100 g/l (range 87-104) and 102 g/l (range 95-114), p = 0.27, in the stapled group and the Surgicel reinforced group, respectively. In the stapled group reinforced with the Surgicel there was one postoperative death. In the solely stapled group there was no postoperative death (p = 0.5). Four out of six pigs in the Surgicel group had massive adhesions to the resection lines. One of these six pigs was sacrificed postoperatively as it was ill and had small bowel obstruction secondary to Surgicel induced adhesions. On the other hand, no adhesions were seen in the solely stapled pigs (p = 0.09). At this point, we can not recommend the use of Surgicel to reinforce resection lines at stapled liver resection in the clinical situation, because of the high frequency of adhesions this material creates.

Animals↗
PubMed1992

Are intersecting staple lines a hazard in intestinal anastomosis?

To determine the safety of intersecting staple lines, 22 pigs were operated upon with a functional end-to-end enteroanastomosis 40 cm distal to the ligament of Treitz using linear stapling devices. The procedure was repeated on the colon, where a colocolostomy was created. The blood flow at intersecting staple lines and single-row staple lines for each anastomosis was studied with the reference organ method 24 hours after the first operation. The purpose was to evaluate whether there is a reduction in blood flow at the site of intersecting staple lines, causing an increased risk for anastomotic leakage. The reduction in mean blood flow in crossing compared with noncrossing staple lines was 6 percent (-5-17 percent) for small bowel anastomoses and 7 percent (-6-19 percent) for colonic anastomoses. An equivalence test showed that, if a reduction in blood flow exists between crossing and noncrossing staple lines, it is most likely less than 30 percent (P less than 0.001) for both small bowel and colonic anastomoses. This experimental study demonstrates that intersecting staple lines in small bowel and colonic anastomoses do not reduce anastomotic blood flow to a dangerous level.

Anastomosis, Surgical↗
PubMed1992

Left-sided hepatectomy with a linear stapling device: an experimental study on pigs.

Thirteen pigs underwent resection of the left liver lobe. By random selection, the animals were resected either with the aid of an RLG 90R linear stapling device or by the conventional finger-fracture technique. There was one postoperative death due to anaesthetic complications. The median operative time using the stapler was 27 min (range 19-40 min) which was significantly shorter (p = 0.0065) than that required for resection by the finger-fracture technique (42.5 min; range 37-55 min). The median blood loss, estimated by counting the number of gauze swabs used, was 425 ml and 275 ml for the finger-fracture resected and stapler resected groups, respectively (ranges 275-550 ml versus 175-300 ml; p = 0.015). The animals were sacrificed and examined one week after the operative procedure. Except for a small bile pseudo-cyst in one pig operated upon with conventional resection, no sign of bleeding or biliary leakage was revealed. This study demonstrates the feasibility of stapling the liver to facilitate resection.

Animals↗
PubMed1989

Total gastrectomy and oesophagojejunostomy with linear stapling devices.

When performing total gastrectomy and oesophagojejunostomy with a circular stapling device two disadvantages are obvious; firstly, a purse-string suture is needed, and secondly the instrument can be extremely difficult to introduce if the oesophagus is narrow, so that the risk of rupture is substantial. We therefore developed the following technique. When the specimen is attached only to the oesophagus, and the Roux-en-Y loop has already been divided with a linear stapling device, a small incision is made on the back wall of the oesophagus and antimesenterically 6 cm distal to the cut end of the Roux-en-Y loop. The two forks of the GIA or the PLC 50 instrument are introduced into the oesophagus and jejunum, and the two organs are brought together at the hiatus. The instrument is closed and fired. The residual opening is closed with a linear stapler which also includes the front wall of the oesophagus. With a knife, the oesophagus and excessive amounts of tissue are trimmed away, and the oesophagojejunostomy is completed. Fifteen patients (median age 67 years) had a postoperative hospital stay of 10 days (range 8-45 days) after this operation. Leakage occurred in one patient and one patient died. The anastomosis took 12 min to perform (range 8-20 min). Three reoperations were needed: intestinal obstruction, leakage and a negative exploration. The median width of the oesophagojejunal anastomosis 6 months after operation was 32 mm (range 27-40 mm). Oesophagojejunostomy performed with two linear staplers allows a quick and reliable anastomosis independent of oesophageal lumen size and a time-consuming purse-string suture.

Adult↗
PubMedDate not supplied

Does desmopressin reduce bleeding in liver surgery? An experimental study on pigs.

The main problem with liver surgery is to control intraoperative bleeding. Bleeding together with postoperative infection and liver failure are the most common causes of postoperative morbidity and mortality in liver surgery. Hospitals with experience of liver resection, report postoperative mortality rates of 3.2%-14.3%. Improved results in liver surgery have been made by refinement of surgical methods and modern techniques. Desmopressin acetate (Octostim) reduces bleeding time by activating platelets and increasing the level of coagulation factor VIII. The purpose with this study was to see if desmopressin could reduce bleeding in a standardized experimental liver resection. Sixteen Swedish domestic pigs were randomized to receive desmopressin 0.3 ug/kg i.v. or placebo, and underwent liver resection with conventional finger fracture technique. The intraoperative blood loss was estimated by several parameters such as pre and postoperative haemoglobin values and by weighing the number of gauze swabs used. One week postoperatively new haemoglobin samples were taken and the pigs were killed. At autopsy the resection area was inspected. All sixteen pigs survived the operation and the postoperative week. There was no significant difference in blood loss between the desmopressin and placebo group. In conclusion, our study showed that desmopressin did not reduce intraoperative bleeding in experimental liver resection.

Animals↗
PubMedDate not supplied

Segmental liver resection with linear stapling device. An experimental study on pigs.

Segmental liver resection was performed in 14 pigs. The pigs were randomized either to resection with conventional finger fracture technique or resection with linear stapling device (TA-90R, US Surgical Corporation). The median time for resection was shorter in the stapled group, although the difference was not statistically significant. The median weight of the specimen was the same in both groups. The median postoperative Haemoglobin value was somewhat lower in the finger fracture resected group as compared to the stapler resected group, 82.5 g/l versus 87.5 g/l, but there was no statistically significant difference between the groups. Blood loss, estimated by counting the number of compresses, amounted to 188 ml for the finger fracture resected group and 181 ml for the stapler resected group. At the post-mortem examination there were no signs of bile leakage or postoperative blood loss in any of the operated animals. This study demonstrates that hepatic resection in the pig can be performed quickly and safely by using linear stapling device. Stapler resection was easier and somewhat quicker to perform than conventional hepatic resection.

Animals↗