Abdominal aortic aneurysm--results of treatment in nonspecialized units.

A retrospective study was made of the management of abdominal aortic aneurysms in eight district general hospitals in Sweden in the period 1971-1980. The numbers of admitted cases rose steadily during these ten years, as did the numbers of operations. Most of the patients had ruptured aneurysm, though there was a manifold rise in the number of operations for asymptomatic aneurysm. The postoperative mortality increased with the level of emergency presented by the aneurysm symptoms, and was about 80% in patients with clinical shock. The results of operative treatment were essentially stable during the study period and they appeared to be similar to those obtained in patients referred to units specializing in vascular surgery. Patient age, preoperative recognition of the diagnosis, concomitance of complicating disease and magnitude of peroperative blood loss seemed to influence the results of surgery. Postoperative deaths tended to occur in the first few days and to be independent of the volume of transfused blood, although severe bleeding was a significant and often fatal postoperative complication.

Changing pattern in aetiology of pancreatitis in an urban Swedish area.

Two groups of patients admitted with a first attack of acute pancreatitis are reviewed. The first group, consisting of 105 patients, was admitted between 1968 and 1969; the second group of 204 patients was admitted between 1974 and 1975. These groups were compared with one of 454 patients admitted between 1956 and 1960 whose details were published earlier by our unit (Edlund et al., 1968). The aim of this study was to determine whether the incidence of factors associated with pancreatitis within the population of the city of Göteborg had changed in the 20-year period. In the 1956--60 group gallstone disease was the main associated factor (68 per cent), but in the later groups alcohol-induced pancreatitis assumed the leading role (68 and 66 per cent respectively). Alcohol-induced pancreatitis tended to occur at a younger age than gallstone pancreatitis. Thirty-one per cent of 449 patients admitted with an acute attack of alcoholic pancreatitis in the two last periods of study had had previous attacks.

Carotid endarterectomy. A review of 104 operations.

A follow-up of 104 carotid endarterectomies in 90 patients is presented. The operations were performed under general anaesthesia with controlled positive pressure ventilation and with peroperative EEG-registration. The patients have been divided into four groups: Group 1: Patients with no neurological symptoms. Group 2: Patients with transitory ischemic attacks (TIA). Group 3: Patients with neurological deficits. Group 4: Patients with cerebro-lesional symptoms. The specific neurological symptoms as well as the early surgical results and the results of the follow-up are presented. An evaluation of different kinds of X-ray examinations and of EEG-registration has been performed.

Abdominal aortic aneurysm. An interhospital study of 171 surgically treated patients.

A retrospective interhospital study of 171 surgically treated patients with atherosclerotic abdominal aortic aneurysm is presented (Orebro and Göteborg). Elective resection of the aneurysm was performed in 94 of the patients and emergency resection because of rupture or suspected rupture of the aneurysm in 77 cases. The mortality within the first postoperative month was 16% in the electively operated patients and 49% in the emergency operated patients. During the last 3 years, the mortality rate among electively operated patients was considerably lower (10%). The five-year survival rate was more than 50% in the electively operated patients. The main difference in long-term survival rate between emergency and electively operated patients was dependent on the primary mortality. The cause of late death was usually not related to the operation of the aneurysm, but to other manifestations of generalized atherosclerotic disease. The results seem to justify the conclusion that atherosclerotic abdominal aortic aneurysm should be resected irrespective of size and symptoms, unless the patient has symptoms of severe arterial hypertension and/or generalized atherosclerosis.