[Causes of need for reoperation following surgery for varicose veins in Denmark]. / Arsager til behov for genbehandling efter variceoperationer i Danmark.

In a surgical varicose vein practice 509 patients who had suffered recurrent varicose veins following surgery in other institutions were traced. The causes of recurrences were identified in a retrospective analysis and related to the source of primary treatment: in hospital treatment (n = 290), surgical practice (n = 56) or another varicose vein specialist (n = 104). A significant difference was noted between the three institutions in the use of saphenofemoral resection (78%, 63% and 97%) as well as greater saphenous vein stripping (44%, 14% and 0%). Lack of or insufficiently performed saphenofemoral surgery were identified as contributing to saphenofemoral insufficiency in 40% and 43% of patients primarily treated in hospital and in surgical practice, respectively, but only in 14% of those treated by a varicose vein specialist (p < 0.001). Primary sapheno-popliteal resection had been used equally infrequently (11%, 13% and 16%, respectively) and was equally frequently insufficiently performed (66%, 57% and 41%). This retrospective investigation concludes that insufficient varicose vein surgery is a major contributor to recurrences, particularly when primary surgery is performed in hospital or in surgical practice, as opposed to in a varicose vein practice. These results warrant a reorganisation of varicose vein surgery in Denmark.

[Agricultural injuries in Ringkjøbing County]. / Landbrugsulykker i Ringkjøbing Amt.

The aim of the study was to investigate agricultural injuries in Ringkjøbing County in the period 1.1-31.12.1992. At the five local hospitals, all persons treated after accidents on farms were registered prospectively and classified according to activity and injury severity (AIS-90). A total of 294 injured persons were registered. Of those, 257 (87%) accidents were due to working activities. Four persons (1%) were killed in the accident. The mean age was 42 years (2-81). Fractures were seen in 32% of the patients and open wounds in 21%. Only 6% had lesions with an AIS-score > 2, and only six patients (2%) had lesions with an AIS-score > 3. In spite of that, 30% were unable to work for more than four weeks because of the injury. An injury prevention programme towards agricultural injuries is therefore suggested.

[Effects of reducing the number of general practitioners on call on the pattern of the use of ambulances and emergency services]. / Storvagtkredses indflydelse på ambulanceudrykningsmønsteret i Ringkøbing Amt.

The aim of the study was to evaluate the effect of a reduction of the number of general practitioners on call on the use of ambulance emergency service. A prospective registration of all ambulance emergency activity in the county of Ringkøbing over an eight week period was made before and after the reduction of the number of general practitioners on call, together with a 4 + 4 week prospective registration of persons who claimed that contact to the general practitioners service was impossible, therefore resulting in a contact to the emergency central or the accident and emergency department. The numbers of emergency calls and emergency ambulance services in the population were unchanged, but there was a significant reduction from 78.9% to 69.3% in the relative number of ambulance services resulting in an admission to hospital of the patient. The number of patients, who claimed that contact to the general practitioner service was impossible was unchanged. We conclude that a reduction of the number of general practitioners on call has resulted in a reduction in the relative number of ambulance services resulting in hospital admission of the patient, which suggests a decline in the threshold of the population for calling an ambulance.

Stone in the ampulla vateri in a child. A case report.

In spite of classic symptoms of gallstones in a 9-year-old girl, operation was delayed for several years, apparently because surgeons and pediatricians do not readily consider the possibility of obstructive gallstones in young patients. The operative treatment is similar in children and adults.

Whole gut irrigation with saline, tinidazole and colistin before colorectal operations.

To date, 27 patients scheduled for colorectal operations have had their bowels prepared the day before operation by whole gut irrigation with up to 151 of an electrolyte solution (14 patients), while the other 13 patients had infused in addition 0.51 of a solution containing 500 mg tinidazole and 1 MIU colistin. During the operation, samples were taken from the abdominal and perineal operation wounds and the colorectal mucosa by a velvet pad rinse technique, which involved transportation in a CO2-atmosphere and cultivation in an anaerobic cabinet. The number of anaerobic bacteria present in the colon was significantly lower after the use of antimicrobials, while there was no such difference with regard to aerobic bacteria. There were no differences between the two groups in preclosure bacterial densities of abdominal and perineal wounds. The total number of bacteria inoculated, the wound inoculum, was considerably lower after antimicrobial administration. There were no infections in the 13 patients treated with these antimicrobials, while 4 out of the 14 patients in the control group developed infections.

Cimetidine for severe gastroduodenal haemorrhage: a randomized controlled trial.

During a period of 12 months, 88 patients with severe haemorrhage from gastric or duodenal ulcers or from erosive gastritis completed a double-blind trial of either cimetidine or placebo. Only patients needing immediate blood transfusion were admitted to the trial. It was found that in patients with severe bleeding from gastric or duodenal ulcers neither the severity of bleeding nor the incidence of emergency surgery was reduced by cimetidine. Furthermore, the treatment did not improve the mortality rate. It is concluded that patients with severe bleeding from gastric or duodenal ulcers will not benefit from immediate treatment with intravenous cimetidine.