Acta chirurgica Scandinavica. Supplementum最新文献

{"title":"The upper gastrointestinal microflora in relation to gastric diseases and gastric surgery.","authors":"S Sjöstedt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The upper gastrointestinal microflora was evaluated in relation to gastric diseases and gastric surgery. Postoperative septic complications and microorganisms found in primary infections were studied in 750 gastric operations. The overall rate of primary infections was 23%. Enterobacteriaceae, enterococci and Bacteroides fragilis were more frequently found in postoperative infections in patients with gastric bleeding or carcinoma. The microbial colonization of the oropharynx, esophagus and stomach was studied in 60 patients. Patients with gastritis, carcinoma and a history of gastric resection harboured more microorganisms in their stomachs than patients with gastric or duodenal ulcers. Patients with gastric carcinoma were colonized with the highest numbers of different microorganisms. The microbial colonization in 23 patients with gastric carcinoma was studied. The tumor was colonized in all patients. Clostridium species were isolated from 57% of the patients. Antibiotic agents used as prophylaxis in gastric cancer surgery should cover both aerobic and anaerobic microorganisms, including B. fragilis. The effect of 400 mg ofloxacin on the microflora in gastric juice was evaluated in 24 patients undergoing gastric surgery. Both the aerobic and anaerobic flora were suppressed on the day of surgery, but increased in number afterwards. There was a significant correlation between gastric pH and the number of microorganisms isolated in the gastric juice. The degree of Campylobacter pylori colonization in relation to other microorganisms on antral mucosal biopsies was investigated in 53 patients with dyspeptic symptoms. Microbial colonization was found in 94% of the patients. Microorganisms other than C. pylori were found irrespective of the diagnoses. C. pylori was with one exception only found in patients with gastritis. No relation between the gastric pH and the microbial colonization of the mucosa was found. The relationship between hospital and catchment area utilization of antimicrobial agents and antibiotic susceptibility of isolated bacteria in primary infections after gastric operations were studied. Over 80% of the antibiotics were used in the catchment area. No major problems with bacterial resistance to antimicrobial agents were found. The pattern of bacterial resistance reflected the use of antimicrobial agents in the catchment area more than that in the hospital.</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"551 ","pages":"1-57"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13880580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alteration of ventricular function during coronary artery surgery.","authors":"D T Mangano","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The alteration in left and right ventricular (LV, RV) function during and immediately following coronary artery bypass surgery has been investigated in four studies, which are summarized here. In a total of 88 patients, anesthetized with morphine in oxygen (O2), basic hemodynamic monitoring and first pass radionuclide angiography were used to document changes in LV and RV function, LV compliance, and the effects of preload augmentation and afterload reduction on LV function. Two groups of patients with different physiologic responses were identified: those with preoperative ejection fractions (EF) greater than 0.50 and no dyssynergy (group I) and those with EF less than 0.50 or with dyssynergy (group II). In group I (n = 14), LV compliance was preserved following bypass (improved in four patients, no change in the remaining 10); normalized LV and RV stroke work were minimally depressed (70% of control); ejection fraction were minimally decreased (5%); and recovery of function occurred within 4 hours following bypass. In group II (n = 8), LV compliance decreased in all patients; RV and LV systolic function was moderately to severely depressed (40% of control); and recovery did not occur within 24 hours after bypass. In both groups, afterload reduction improved cardiac index, stroke volume index, and LV stroke work index after bypass, but the effects were more pronounced in group II patients. Preload augmentation with 1,500 ml of volume was not effective in either group when wedge pressure exceeded the normal ranges. Thus, significant ventricular dysfunction (RV and LV; systolic and diastolic) occurs during the immediate and prolonged post-bypass periods and can be predicted from the preoperative ejection fraction and degree of dyssynergy.</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"550 ","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13924294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of soft tissue sarcomas with interferon with special reference to general features of interferon therapy.","authors":"P Gröhn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"549 ","pages":"50-1"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13613010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CA 50 and CA 19-9 in serum as tumor markers for pancreatic cancer: a review of the literature.","authors":"A Andrén-Sandberg","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"549 ","pages":"75-81"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13790720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interactions of cytokines in the host.","authors":"K Lundholm","doi":"10.1007/978-3-642-74709-0_4","DOIUrl":"https://doi.org/10.1007/978-3-642-74709-0_4","url":null,"abstract":"","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"549 ","pages":"31-4"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13790716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic technique and surgical convalescence.","authors":"H Kehlet","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This brief review presents an update of studies on postoperative fatigue and convalescence and the way in which they are affected by anesthetic technique. Development of postoperative fatigue is related to the degree of surgical trauma, but not to general anesthesia, and it cannot be predicted from age, sex, duration of surgery, or preoperative assessment of various nutritional parameters. Postoperative fatigue correlates with deterioration in nutritional status and impaired adaptability of heart rate to orthostatic stress and bicycle exercise. Decreases in muscle performance and endurance are associated with postoperative fatigue, but psychological factors such as preoperative degree of anxiety do not appear to be important factors. Pain relief with regional anesthetics does not improve postoperative fatigue after abdominal surgery; however, no studies are available that evaluate the effects of regional analgesia with concomitant inhibition of the stress response. Controlled studies suggest that the use of regional anesthesia with local anesthetics reduces duration of hospitalization and time to ambulation. Further studies are needed to define the relative roles of immobilization, impaired nutritional intake, and surgical stress response in the pathogenesis of postoperative fatigue.</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"550 ","pages":"182-8; discussion 188-91"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13793281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The stress response to surgery: release mechanisms and the modifying effect of pain relief.","authors":"H Kehlet","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This short review updates information on the release mechanisms of the systemic response to surgical injury and the modifying effect of pain relief. Initiation of the response is primarily due to afferent nerve impulses combined with release of humoral substances (such as prostaglandins, kinins, leukotrienes, interleukin-1, and tumor necrosis factor), while amplification factors include semi-starvation, infection, and hemorrhage. The relative role of the various signals in producing the complex injury response has not been finally determined, but the neural pathway is probably most important in releasing the classical endocrine catabolic response, while humoral factors are important for the hyperthermic response, changes in coagulation and fibrinolysis immunofunction, and capillary permeability. The modifying effect of pain relief on the surgical stress response is dependent upon the technique of analgesia. However, the effect on humoral-mediated responses is small, regardless of the technique used. Afferent neural blockade with local anesthetics is the most effective technique for reducing the endocrine-metabolic response, but only in operations in the lower part of the abdomen, probably because of insufficient afferent blockade during thoracic epidural analgesia. Systemic opiate administration, as well as non-steroidal antiinflammatory drugs, exert only a small modifying effect on the response. Low-dose combined analgesic regimens may provide total pain relief, but exert no important effect on the stress response. In summary, pain alleviation itself may not necessarily lead to an important modification of the stress response, and a combined approach with inhibition of the neural and humoral release mechanisms is necessary for a pronounced inhibition or prevention of the response to surgical injury.</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"550 ","pages":"22-8"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13793282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoptive immunotherapy in gastrointestine malignancies using interleukin-2. Current results and future prospects.","authors":"G D Marshall","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"549 ","pages":"71-4"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13924421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure of peripheral arterial reconstruction.","authors":"A D Whittemore","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Infrainguinal arterial reconstruction utilizing autogenous vein grafts provides acceptable results in most cases, yet 15-25% of such grafts fail during the first 5 years. Secondary reconstruction, especially when vein graft failure is identified prior to total thrombosis, frequently restores significant patency although multiple attempts may be required. While the reasons for initial graft failure are understood in many cases, a significant number of early failures occur within 30 days without a specific cause being determined. While the in situ technique combined with completion angiography has reduced the incidence of these early failures, in order to effect further reductions, surgical and anesthetic management must address such diverse entities as vasospasm, hypercoagulopathy, embolization, and systemic hypotension.</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"550 ","pages":"74-80"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13852865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Studies in longstanding ulcerative colitis with special reference to malignant transformation of the colorectal mucosa.","authors":"R Löfberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The risk of colorectal carcinoma was estimated retrospectively in a cohort of patients with ulcerative colitis from three defined geographical areas (West Midlands and Oxford regions, England and Stockholm County, Sweden). The cohort consisted of 824 primary referral patients with a diagnosis of ulcerative colitis established within five years from onset of symptoms between 1945-1965. All patients were 15 years of age or more at onset and they were followed for a minimum of 17 years and a maximum of 38 years. There was an eight-fold risk of developing colorectal cancer in the series as a whole, relative to that of the general population. In extensive colitis the risk was nineteen-fold. The cumulative risk of developing cancer in extensive colitis was 12% after 25 years of disease duration. No significant effects of the cancer risk for age at onset, sex or referral centre were detected. Abnormal, aneuploid DNA-content of cell nuclei in colorectal mucosal biopsies was found in five out of 53 patients with longstanding, total ulcerative colitis in a prospective study using flow cytometric DNA-analyses. Findings of DNA-aneuploidy were found at repeated examinations in four of these patients and there was a correlation with precancerous, mucosal changes (dysplasia) found at histological examination. In one patient DNA-aneuploidy preceded the finding of a carcinoma (Dukes' A) in the colon. Microspectrophotometry of imprint preparations from mucosal biopsies was compared to flow cytometry for detection of nuclear DNA-aneuploidy in seven patients with ulcerative colitis in a prospective study. DNA-aneuploidy was detected in five patients in eight separate locations of the colon and rectum. There was a good conformity between the two methods in the detection of DNA-aneuploidy, which was detected in non-dysplastic mucosa as well as in association with dysplasia. In a fifteen year follow-up surveillance program, comprising 72 patients with total ulcerative colitis, colonoscopy was performed at fixed intervals and biopsies sampled from ten predetermined locations in the colon and rectum. Definite dysplasia developed in 12 patients, two of which had carcinoma (Dukes' A). Nine patients were selected for prophylactic colectomy due to findings of dysplasia. A sequential development of dysplasia was found in seven patients. The cumulative risk of developing at least low grade dysplasia was 14% after 25 years of disease duration. Using flow cytometry, DNA-aneuploidy was detected in 12 out of 59 patients, significantly correlating with low and high grade dysplasia.(ABSTRACT TRUNCATED AT 400 WORDS)</p>","PeriodicalId":7309,"journal":{"name":"Acta chirurgica Scandinavica. Supplementum","volume":"552 ","pages":"1-45"},"PeriodicalIF":0.0,"publicationDate":"1989-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13938928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}