[Femoro-popliteal bypass surgery in Denmark 1983-1987]. / Femoro-popliteal bypass-kirurgi i Danmark 1983-1987.

In a retrospective study of femoro-popliteal bypass surgery in Denmark during the period 1983 to 1987, a total of 1,532 operations were performed. Approximately 2/3 of the patients were operated upon for limb salvage, the remainder for severe disabling claudication. The perioperative lethality was below two per cent in all departments. Early occlusion rate was found to be between 21 and 11 per cent, leading to major amputation in about half of the patients.

[Femoro-crural reconstruction in Denmark 1983-1987]. / Femoro-krurale rekonstruktioner i Danmark 1983-1987.

From 1983 to 1987, 293 femoro-crural bypasses were performed in eight centers for vascular surgery in Denmark. The activity increased in the period from 15 to 135 bypasses per year. The increase took place particularly 1986, when the in situ saphenous vein bypass was introduced in Denmark. A total of 203 bypasses were performed at the University Hospital of Copenhagen, Rigshospitalet: 108 in situ bypasses, 51 bypasses with arterial protheses and 44 bypasses using reversed vein. The cumulated graft patency after one year was 76% for the in situ bypasses, 26% for the bypasses with arterial protheses and 32% for reversed vein. The cumulated limb survivals after one year were 90%, 66% and 63%, respectively.

[Surgical treatment of abdominal aorta aneurysm 1983-1987. A multicenter study. 1266 operations, development and early results]. / Operative behandling af abdominalt aorta-aneurysme 1983-1987. Multicenterundersøgelse. 1,266 operationer, udvikling og tidlige resultater.

During the years 1983-1987, 1,266 operations for abdominal aortic aneurysm (AAA) were carried out in eight surgical departments with vascular surgical function. The activity increased constantly corresponding to 311 patients in 1987 or 50% more than in 1983. During this period the distribution between patients subjected to elective operation and those operated upon as emergencies was very uniform. In the latter group, only a slight increase in the number of AAA patients with rupture was observed. The risk of complications was low with a significant decrease in the need for dialysis. The early mortality was constant for the patients subjected to elective operation remained constant about 5.5%. A marked decrease in the early mortality was observed for the patients operated upon as emergencies with rupture from 63 to 50% and without rupture from 37 to 25%. At the conclusion of the period, ultrasonic scanning became the preoperative investigation of election and introduction of an aortic prosthesis the method of operation of election. Patients with AAA should be recognized so that elective surgery can be offered before a condition endangering life develops.

[Vascular surgery in Denmark]. / Karkirurgi i Danmark 1983-1987.

This report presents vascular surgical operations performed in Denmark 1983-1987, the first five years after the establishment of the speciality. The number of vascular surgical operations increased by 18 per cent during the five years to nearly 2,000 operations in 1987. Approximately 50 per cent of all vascular procedures were intraabdominal operations, while 30 per cent were peripheral reconstructions. In 1987 40 operations/100,000 inhabitants were made, a level considerably below the activity performed in the other Scandinavian countries. We conclude that vascular surgical activity will increase in Denmark in the years to come.

Aneurysm of an arterial prosthesis. A case report.

A case of aneurysm formation in knitted double velour Dacron graft bypassing the abdominal aorta is presented. The complication appeared 46 months after implantation. The defective graft segments were resected and replaced by new pieces of the same material. Microscopy, surprisingly, indicated a graft-vs.-host reaction as cause of the fiber degeneration.

Ischemic colitis complicating reconstruction of the abdominal aorta.

A review of 23 patients with ischemic colitis after surgical treatment of the abdominal aorta disclosed a pathogenetic heterogeneous finding. Ligation of the inferior mesenteric artery, abolished collateral blood supply or nonocclusive low flow state, or both, was a common feature. An incidence of 0.5 per cent was revealed for full-thickness necrosis. The mortality was 70 per cent since diagnosis was made first since perforation and peritonitis had occurred. On the basis of these findings vital prophylactic measures and diagnostic possibilities are discussed herein.

Prognosis and treatment of abdominal aortic aneurysm.

The records of 109 patients operated upon for ruptured or nonruptured abdominal aortic aneurysms in the period from 1961 to 1975 were analyzed, with special attention being given to hospital mortality and the long term survival rate. It was found that a hospital mortality of 67 per cent occurred in patients operated upon for ruptured aortic aneurysms as well as a lethality rate of 40 per cent for patients operated upon urgently for nonruptured aortic aneurysms, whereas the lethality rate was only 4.5 per cent for patients operated upon electively. Subsequent to surgical treatment, an imposingly high mortality occurred in both groups of patients in relation to the normal population, so that only about 10 per cent of the patients operated upon for abdominal aortic aneurysms were living after a period of eight years. The most frequent causes of death in both groups of patients were illnesses resulting from other cardiovascular manifestations or complications in connection with the implanted prosthesis. By optional operation of the nonruptured aortic aneurysm, a gain in the number of patient years could be obtained within the first five years after the operation. However, careful evaluation of the cardiovascular status of the patient is recommended before deciding upon an operation.

The haemostatic effect of purse-string suture in transvesical prostatectomy: a controlled clinical trial.

In a series of 64 consecutive cases of transvesical prostatectomies it is shown that the use of a purse-string suture at the bladder neck significantly reduces the postoperative blood loss. A follow-up 3 months after operation has shown that the suture did not increase the number of either bladder neck stenoses, urinary incontinences, urinary infections or secondary lithiases.

Double vas deferens and epididymis associated with ipsilateral renal agenesis simulating ectopic ureter opening into the seminal vesicle.

A 26-year-old man presented clinical, radiographic and, at operation, macroscopic signs of an ectopic opening of the left ureter into the seminal vesicle and agenesis of the left kidney. However, histological examination of the surgical specimen revealed that the supposed ureter was actually a vas deferens, and the structure removed from the renal site showed a histological composition like that the epididymis. The anomaly observed was thus a retroperitoneal duplication of the vas deferens and epididymis and failure of development of the ipsilateral kidney and ureter.

Malrotation of the duodenum. Frequency in a radiographic control group.

In a prospective radiographic study, abnormal configurations with kinking and torsion (malrotation) of the duodenum were found in 41% of 150 non-dyspeptic subjects. Malrotation of the duodenum (MD) was more frequent before the age of 30, and in the entire series the frequency decreased significantly with age from approximately 60% at 20 years to approximately 25% in individual aged 35 years or more. It should be considered whether the same radiographic configuration as in MD up to the age of 30--35 years is merely due to uncompleted disposition and fixation of the duodenum, so that the diagnosis of MD cannot be definitely established until after that age. In the presence of MD, the luminal diameter of the duodenum was larger than normal, and there was a greater tendency to gastric retention at 4 hours after the barium meal.

Malrotation of the duodenum and duodenal ulcer.

In 173 patients with surgically confirmed duodenal ulcer, malrotation of the duodenum (MD) was found in the pre-operative radiographs in a total of 54% without significant differences in the age and sex distribution. As compared with a control group, the frequency of MD was significantly increased in men and in patients over 50 years (Table I). The luminal diameter in the presence of MD was larger in the ulcer patients than in the control group (Table II). Gastric retention at 6 hours after the barium meal was more frequent in ulcer patients with MD than in those with normal duodenal configuration, and in both groups more frequent than in the control group. At a follow-up examination at least 12 months after the operation for duodenal ulcer, a significant tendency to a poorer result was revealed in patients with MD, manifested by persistent or postoperatively developed postcibal pain, fullness, nausea and vomiting (Table III-V), except in patients who had undergone parietal-cell vagotomy without pyloroplasty. The latter observation suggests that, in the presence of MD, preserved pyloric function is of significance in the frequency of subsequent manifest symptoms of this anomaly.

Treatment of Whipple's disease with sulphamethoxazole-trimethoprim.

A patient with Whipple's disease responding rapidly to sulphamethoxazole-trimethoprim is described. In spite of initial folate deficiency, the drug was well tolerated for one year. It is proposed that a sulphonamide combined with trimethoprim should be the drug of first choice in the treatment of Whipple's disease. Repeated jejunal biopsy is suggested as the best way to record the effectiveness of treatment.