Exploring the limitations of an adult-led agenda for understanding the health behaviours of young people

Public health and health promotion agendas are usually determined by adults, even when the 'target' population is children and young people. Adult-centred frameworks for health maintenance and the promotion of well-being risk ignoring young people's conceptualizations and experiences of health and health-relevant behaviours. However, the current policy emphasis in the UK and elsewhere apparently seeks to position young people at the centre of their own health-related decisions. Building on the United Nations Convention on the Rights of the Child, this paper examines and critiques policies relating to young people in UK, European and worldwide contexts. This paper then introduces data from two qualitative studies conducted in the UK. These studies illustrate that young people's definitions of health often run counter to prevailing public health and health promotion discourses. Young people do, however, often exhibit strategies for managing their health, even though they are frequently restricted by the perceptions that adults have about their lives and behaviour. This paper argues that the new policy discourse is not yet being systematically turned into action to give all young people a voice. This is important to begin to understand young people's perspectives about what matters to them and what really influences their health behaviours.

Linked models to assess the impacts of climate change on nitrogen in a Norwegian river basin and FJORD system

Dynamically downscaled data from two Atmosphere-Ocean General Circulation Models (AOGCMs), ECHAM4 from the Max-Planck Institute (MPI), Germany and HadAm3H from the Hadley Centre (HAD), UK, driven with two scenarios of greenhouse gas emissions (IS92a and A2, respectively) were used to make climate change projections. These projections were then used to drive four effect models linked to assess the effects on hydrology, and nitrogen (N) concentrations and fluxes, in the Bjerkreim river basin (685-km(2)) and its coastal fjord, southwestern Norway. The four effect models were the hydrological model HBV, the water quality models MAGIC, INCA-N and the NIVA FJORD model. The downscaled climate scenarios project a general temperature increase in the study region of approximately 1 degrees C by 2030-2049 (MPI IS92a) and approximately 3 degrees C by 2071-2100 (HAD A2). Both scenarios imply increased winter precipitation, whereas the projections of summer and autumn precipitation are quite different, with the MPI scenario projecting a slight increase and the HAD scenario a significant decrease. As a response to increased winter temperature, the HBV model simulates a dramatic reduction of snow accumulation in the upper parts of the catchment, which in turn lead to higher runoff during winter and lower runoff during snowmelt in the spring. With the HAD scenario, runoff in summer and early autumn is substantially reduced as a result of reduced precipitation, increased temperatures and thereby increased evapotranspiration. The water quality models, MAGIC and INCA-N project no major changes in nitrate (NO(3)(-)) concentrations and fluxes within the MPI scenario, but a significant increase in concentrations and a 40-50% increase in fluxes in the HAD scenario. As a consequence, the acidification of the river could increase, thus offsetting ongoing recovery from acidification due to reductions in acid deposition. Additionally, the increased N loading may stimulate growth of N-limited benthic algae and macrophytes along the river channels and lead to undesirable eutrophication effects in the estuarine area. Simulations made by the FJORD model and the HAD scenario indicate that primary production in the estuary might increase up to 15-20%, based on the climate-induced changes in river flow and nitrate concentrations alone.

Measurements of eosinophil activation before and after food challenges in adults with food hypersensitivity

BACKGROUND

Objective assessment of inflammatory reactions in the gastrointestinal tract could be useful in the diagnosis of food hypersensitivity. The aim of the present study was to investigate the involvement of eosinophils and mast cells in the inflammatory response of patients with food hypersensitivity before and after food challenges.

METHODS

Eleven patients (4 with IgE-mediated allergy and 7 without) with food hypersensitivity and positive double-blind, placebo-controlled food challenge were subjected to food challenge in a single-blinded fashion. Four subjects with no known food hypersensitivity were recruited as controls. Placebo was given after a 1-week washout period followed by an active dose. Stool, urinary and serum samples were collected and symptoms were recorded in a diary. Fecal samples were analyzed for eosinophil protein X (F-EPX) and tryptase; urinary samples for EPX (U-EPX) and leukotriene E4 (U-LTE4) and serum samples were analyzed for eotaxin and food-specific IgE antibodies.

RESULTS

Patients with IgE-mediated food allergy had increased levels of F-EPX compared to controls and tended to have lower serum levels of eotaxin compared to non-allergic patients and controls. U-LTE4 was significantly higher in allergic patients compared to non-allergic patients after challenge. Moreover, F-EPX correlated to U-LTE4 (p = 0.011). Reported symptoms, abdominal pain, distension, flatulence and nausea were similar in the allergic and non-allergic patients.

CONCLUSION

The results strongly indicate that eosinophils are activated in the gastrointestinal tract of food-allergic patients but not in patients with non-allergic food hypersensitivity. Due to the inconsistent pattern of symptoms after placebo and active food challenge, it was not possible to relate the levels of inflammation markers to the recorded symptoms.

Alterations in glucose homeostasis in SSTR1 gene-ablated mice

SSTR1 is found on the majority of human pancreatic beta cells, however, its role in insulin secretion has yet to be elucidated. In this study, we used the SSTR1 knockout mouse model to examine the role of SSTR1 in insulin secretion and glucose homeostasis in mice. Despite the reported effect of SSTR1 in inhibiting growth hormone secretion, SSTR1-/- mice had significantly reduced body weight with growth retardation. Perfusion of isolated mouse pancreata at 3 months of age demonstrated a significant increase in insulin secretion in SSTR1-/- mice compared with that of WT controls. We also found that at 3 months of age, SSTR1-/- mice had significantly decreased levels of systemic insulin secretion and were glucose intolerant. However, SSTR1 gene-ablated mice had a much higher rate of insulin clearance compared to WT mice at the same age. When challenged at 12 months of age, we found SSTR1-/- mice had increased glucose tolerance with exaggerated increase of insulin levels at the end of the experiment. Immunochemical analysis showed that the pancreatic islets of SSTR1-/- mice had significantly decreased levels of somatostatin staining and a significant decrease of SSTR5 expression. These results demonstrate that SSTR1 plays an important role in the regulation of insulin secretion in the endocrine pancreas in mice.

The effect of global SSTR5 gene ablation on the endocrine pancreas and glucose regulation in aging mice

INTRODUCTION

The purpose of this study was to examine the effect of global gene ablation of SSTR5 on the endocrine pancreas, insulin secretion, and glucose tolerance in aging mice, as SSTR5 is a primary regulator of insulin secretion in the mouse pancreas.

METHODS

Global SSTR5-/- mice were generated and genotypes were verified using Southern blot and RT-PCR. Glucose tolerance and in vivo insulin secretion in SSTR5-/- and WT mice were examined using intraperitoneal glucose tolerance test (IPGTT;1.2-2.0 mg/kg) at 3 and 12 months of age (n = 8 per group). Basal and glucose-stimulated insulin secretion in vitro was studied using the isolated perfused mouse pancreas model at 3 and 12 months. Pancreata were removed and levels of insulin, glucagon, somatostatin, and SSTR1 were studied using immunohistochemical analysis along with H&E staining of the pancreata.

RESULTS

Genotyping verified the absence of SSTR5 in SSTR5-/- mice. IPGTT demonstrated that 3-month-old SSTR5-/- mice were glucose intolerant despite similar insulin secretion both in vivo and in vitro and enlarged islets. At 12 months of age, SSTR5-/- mice had basal hypoglycemia and improved glucose intolerance associated with hyperinsulinemia in vivo and in vitro and enlarged islets. SSTR5-/- mice had increased insulin clearance at 3 and 12 months of age. SSTR1 expression was significantly increased in islets at 3 months of age, but was nearly absent in islets at 12 months of age, as was somatostatin staining in SSTR5-/- mice.

CONCLUSIONS

These results suggest that both SSTR5 and SSTR1 play a pivotal role in insulin secretion and glucose regulation in mice and that their regulatory effects are age-related.

SSTR5 ablation in islet results in alterations in glucose homeostasis in mice

Somatostatin (SST) peptide is a potent inhibitor of insulin secretion and its effect is mediated via somatostatin receptor 5 (SSTR5) in the endocrine pancreas. To investigate the consequences of gene ablation of SSTR5 in the mouse pancreas, we have generated a mouse model in which the SSTR5 gene was specifically knocked down in the pancreatic beta cells (betaSSTR5Kd) using the Cre-lox system. Immunohistochemistry analysis showed that SSTR5 gene expression was absent in beta cells at three months of age. At the time of gene ablation, betaSSTR5Kd mice demonstrated glucose intolerance with lack of insulin response and significantly reduced serum insulin levels. Insulin tolerance test demonstrated a significant increase of insulin clearance in vivo at the same age. In vitro studies demonstrated an absence of response to SST-28 stimulation in the betaSSTR5Kd mouse islet, which was associated with a significantly reduced SST expression level in betaSSTR5Kd mice pancreata. In addition, betaSSTR5Kd mice had significantly reduced serum glucose levels and increased serum insulin levels at 12 months of age. Glucose tolerance test at an older age also indicated a persistently higher insulin level in betaSSTR5Kd mice. Further studies of betaSSTR5Kd mice had revealed elevated serum C-peptide levels at both 3 and 12 months of age, suggesting that these mice are capable of producing and releasing insulin to the periphery. These results support the hypothesis that SSTR5 plays a pivotal role in the regulation of insulin secretion in the mouse pancreas.

Ageing before mating and quinacrine ameliorate the expression of abnormal oocyte (abo) in homozygous Drosophila melanogaster females

Several studies have shown that the characteristically skewed sex ratio among the progeny of abo homozygous females, derived from heterozygous stocks and mated to attached XY males, can be modified during homozygous stock-keeping. This amelioration seems to have a complex mechanistic background, and both loss of the blood transposon from chromosome 2, where abo is located, and amplification of a specific heterochromatic element (ABO) have been suggested to work in this direction. There is also an increased frequency of non-disjunction associated with abo, beside the poor recovery of X0 males. Experiments were performed to see if there was a coordinated loss of both phenotypic expressions during homozygous stock-keeping and if non-disjunction was amenable to modification by quinacrine. We found an unexpected spontaneous amelioration of the phenotypic expressions of abo despite heterozygous stock-keeping. The spontaneous amelioration of non-disjunction and male lethality under heterozygous condition was coordinated while the process initiated by homozygosity slowly decreased non-disjunction and rapidly increased male recovery over generations, which may point to a mechanistic difference between the amelioration processes. Quinacrine was found to ameliorate the skewed sex ratio but did not affect non-disjunction. In these experiments larval and adult treatment, respectively, were employed and the respective controls revealed that also ageing before mating significantly increased male recovery and reduced non-disjunction. Ageing before mating and quinacrine seemed to act additively on male recovery, suggesting independent action, while interaction could be suspected between quinacrine and some ameliorating factor associated with brood. Some of the results also suggest that quinacrine acts indirectly and does not substitute for the abo gene product. Due to the action of quinacrine in other biological systems it is speculated that the compound compensates for a biochemical aberration in abo/abo females or their progeny, showing some relation to phospholipase activity and/or actin polymerisation state.

Interpretation of subjective symptoms in double-blind placebo-controlled food challenges - interobserver reliability

BACKGROUND

Subjective symptoms after food challenges are difficult to interpret and no standard is available. We discuss a strategy for how to interpret a diary. Furthermore, the interobserver reliability is evaluated.

METHODS

Diaries for 32 patients with subjective symptoms were used. The diaries were re-evaluated with a predefined strategy by three independent observers.

RESULTS

The proportion of positives was 21.9% among the old diagnoses, according to the new approach 34.4% (observers I and II) and 37.5% (observer III) were positive. The new approach had high interobserver reliability (97 and 100%).

CONCLUSIONS

The proportion of positives depends on how subjective symptoms are interpreted. Interpretations of subjective symptoms in diaries could be made with high interobserver reliability.

Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia

AIM

The main aim of the study was to describe the differences between some Northern countries regarding what foods, according to the patients, elicit hypersensitivity symptoms.

METHODS

At the participating clinics, patients with a history of food hypersensitivity (n = 1139) were asked to fill in a questionnaire in which 86 different foodstuffs were listed. Skin-prick tests (SPT) were performed with common inhalant allergens.

RESULTS

The foods that were reported as eliciting symptoms differed between countries. In Russia, Estonia, and Lithuania; citrus fruits, chocolate, honey, apple, hazelnut, strawberry, fish, tomato, egg, and milk were most often reported as causes of hypersensitivity. In Sweden and Denmark; birch pollen (BP) related foods, such as nuts, apple, pear, kiwi, stone fruits, and carrot were the most common causes. In all countries, children, more often than adults, had symptoms of allergic reaction to citrus fruits, tomato, strawberry, milk, egg, and fish. Most patients (95%) reported hypersensitivity to several foodstuffs (median: eight foods). The most common symptoms were oral allergy syndrome and urticaria. Severe symptoms were most common with fish, shellfish, nuts, and milk. Slight symptoms were most common with rice, coriander, poppy seed, lingonberry, corn, caraway red currant, and fig. Earlier well-known correlations, such as that between BP sensitization and some fruits and vegetables, as well as that between mugwort and some spices, were conoborated. Positive correlations were found between self-reported hypersensitivity to crustaceans and SPT with horse. A negative correlation was seen between hypersensitivity to crustaceans and SPT with BP.

CONCLUSIONS

The foodstuffs that often are reported to cause food hypersensitivity, differ between Sweden/Denmark on one side and the Baltic States and Russia on the other. BP-related foods dominate in Scandinavia, whereas some mugwort-related foods are of more importance in Russia and the Baltic States.

A kinetic study in adults with food hypersensitivity assessed as eosinophil activation in fecal samples

BACKGROUND

Immune-mediated food hypersensitivity affecting the gut is difficult to evaluate, and objective tools to diagnose local gastrointestinal (GI) inflammatory reactions are lacking.

OBJECTIVES

To determine whether allergic manifestations in adults with a history of food-related GI symptoms could be assessed in feces during symptomatic and non-symptomatic periods, using the surrogate markers, eosinophil cationic protein (ECP), eosinophil protein X (EPX) and myeloperoxidase (MPO).

METHODS

Thirteen subjects with food hypersensitivity-related GI symptoms, confirmed by a positive double-blind placebo-controlled food challenge (DBPCFC), were subjected to an open kinetic food challenge design for 6 weeks. Symptoms were recorded and scored during the 3-week study period and stool samples were obtained every day. The surrogate markers ECP, EPX and MPO were measured in the supernatants from feces samples.

RESULTS

A significant increase in abdominal pain, distension and flatulence was observed during challenge, with a gradual decrease during elimination diet. Both between days and subjects, EPX levels were more frequently increased compared to ECP and MPO. Individuals with a history of a short duration of symptoms had significantly higher mean levels of EPX and MPO than those with a longer duration of symptoms.

CONCLUSIONS

An overall increase in levels of eosinophil markers, in particular EPX, was observed in feces from patients with food-related GI symptoms. However, rather than being a tool to differentiate symptomatic from non-symptomatic periods, EPX might be used for detecting an ongoing clinical or subclinical chronic inflammation, that may have an impact on the patient's clinical course of GI symptoms.

The hazards of kissing when you are food allergic. A survey on the occurrence of kiss-induced allergic reactions among 1139 patients with self-reported food hypersensitivity

BACKGROUND

According to a few case reports, kissing can induce symptoms due to food allergy.

OBJECTIVE

We wanted to investigate the occurrence of kiss-induced allergic symptoms and other social inconveniences among patients with self-reported food hypersensitivity.

METHODS

A questionnaire was answered by 1139 patients (1-84 years old, mean age 29 years, 393 males and 746 females) who considered themselves to be food allergic.

RESULTS

12% of the patients experienced allergic symptoms when in close contact with (e.g., kissing) a person who had eaten a nontolerated food prior to the contact. Some case histories suggested that the symptoms only appeared if the food intake had occurred immediately before the kiss. In addition, the questionnaires showed that 55% had problems in daily life finding tolerable food, 44% were afraid of a severe reaction from eating nontolerated food, 13% could experience symptoms when sitting beside a person who was eating such a food, and 17% could experience symptoms in the kitchen when someone else was preparing such food.

CONCLUSIONS

What other people eat can influence the quality of life of food-allergic patients.

High frequency of LOH, MSI and abnormal expression of FHIT in gastric cancer

The FHIT gene is a putative tumour suppressor gene. In this study, we analysed a set of 50 gastric tumours for alterations of FHIT, and found 38 of 45 tumours (84%) exhibiting loss of heterozygosity (LOH) within the FHIT gene. We used both nested Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) and single step RT-PCR to analyse the FHIT transcripts and found 34 of 39 (87%) tumours and seven of the 11 (64%) corresponding non-cancerous tissues showed low or aberrant expression of FHIT mRNA and the appearance of the aberrant FHIT transcripts depended on the conditions of the RT-PCR. In these aberrant transcripts, frequent deletions and/or insertions were detected by direct sequencing. All breakpoints for deletions and insertions were at splicing sites. All insertions came from the adjacent introns, whose appearance was completely in accordance with the 'GU-AG' rule for pre-mRNA splicing. It may be suggested that an alternative splicing mechanism functions in the formation of these aberrant transcripts. The fragile nature of FRA3B within the FHIT gene could be responsible for the formation of the aberrant mRNA. Negative or reduced Fhit expression was detected in 39 of 50 tumours (78%). Moreover, an association was found between abnormal Fhit expression and positive node status (P=0.012). Thirteen of 48 tumours (27%) displayed microsatellite instability (MSI), among which 10 tumours also showed MSI within the FHIT gene. Furthermore, we detected an association between MSI and negative node status (P=0.02). We conclude that the abnormalities of FHIT, presumably associated with the unstable nature of FRA3B within the FHIT gene, are involved in the carcinogenesis of gastric cancer, and lack of mismatch repair (MMR) could possibly promote its alteration in a subset of gastric tumours.

Lactobacillus coryniformis subsp. coryniformis strain Si3 produces a broad-spectrum proteinaceous antifungal compound

The antifungal activity spectrum of Lactobacillus coryniformis subsp. coryniformis strain Si3 was investigated. The strain had strong inhibitory activity in dual-culture agar plate assays against the molds Aspergillus fumigatus, A. nidulans, Penicillium roqueforti, Mucor hiemalis, Talaromyces flavus, Fusarium poae, F. graminearum, F. culmorum, and F. sporotrichoides. A weaker activity was observed against the yeasts Debaryomyces hansenii, Kluyveromyces marxianus, and Saccharomyces cerevisiae. The yeasts Rhodotorula glutinis, Sporobolomyces roseus, and Pichia anomala were not inhibited. In liquid culture the antifungal activity paralleled growth, with maximum mold inhibition early in the stationary growth phase, but with a rapid decline in antifungal activity after 48 h. The addition of ethanol to the growth medium prevented the decline and gave an increased antifungal activity. The activity was stable during heat treatment and was retained even after autoclaving at 121 degrees C for 15 min. Maximum activity was observed at pH values of between 3. 0 and 4.5, but it decreased rapidly when pH was adjusted to a level between 4.5 and 6.0 and was lost at higher pH values. The antifungal activity was fully regained after readjustment of the pH to the initial value (pH 3.6). The activity was irreversibly lost after treatment with proteolytic enzymes (proteinase K, trypsin, and pepsin). The antifungal activity was partially purified using ion-exchange chromatography and (NH(4))(2)SO(4) precipitation, followed by gel filtration chromatography. The active compound(s) was estimated to have a molecular mass of approximately 3 kDa. This is the first report of the production of a proteinaceous antifungal compound(s) from L. coryniformis subsp. coryniformis.

Expression of CD1d in the duodenum of patients with cow's milk hypersensitivity

CD1 cell surface glycoproteins represent a family of non-major histocompatibility complex (MHC) encoded antigen-presenting molecules. All members of the CD1 family appear to mediate the recognition of microbial or endogenous lipid and glycolipid antigens. The recognition of CD1d by a unique subset of natural killer (NK) T cells that leads to rapid production of large amounts of both type 1 and type 2 cytokines can be augmented by some synthetic glycolipids. Because of the proposed role of such CD1d-restricted T cells in immunoregulation, we hypothesized that CD1d molecules participate in mucosal immune responses in patients with gastrointestinal symptoms owing to food hypersensitivity. Patients of that category represent a heterogeneous group in which poorly defined immunological mechanisms are believed to contribute to disease pathogenesis. The expression of CD1 in duodenal biopsy samples from six patients with verified intolerance to cow's milk and six healthy controls was studied by immunoperoxidase staining of cryostat sections using a panel of mouse monoclonal antibodies (MoAbs) specific for CD1a, b, c, and d. Large numbers of CD1d positive cells were found in the lamina propria of all the patients, both during the symptomatic and the asymptomatic periods, whereas healthy controls were virtually devoid of CD1d expression in the duodenum. The localization of CD1d positive cells corresponded to areas where B cells, plasma cells and dendritic cells (DC) were present. A positive correlation was found between the numbers of CD1d(+) and CD19(+) cells in the lamina propria. In contrast to previous reports, no CD1d expression was found on the epithelial cells. Although less numerous than CD1d(+) the CD1c(+) cells were also present in all the patients and in five out of six controls. No staining for CD1a or CD1b was detected in the duodenal biopsy samples from any of the subjects. The exclusive presence of CD1d in the duodenal lamina propria of the patients with cow's milk hypersensitivity might suggest the participation of these molecules in the pathogenesis of allergic reactions to food.

The effect of mismatch repair deficiency on tumourigenesis; microsatellite instability affecting genes containing short repeated sequences

We have investigated microsatellite instability (MSI) in colorectal, gastric, endometrial and ovarian cancer as a result of mismatch repair (MMR) deficiency. We detected frameshift mutations in several genes that carry short repeated sequences and are important in cell fidelity and growth control; hMSH3, hMSH6, BAX, IGFIIR, TGFbetaIIR, E2F4 and BRCA2. Accumulation of mutations was heterogeneous and mainly restricted to tumours showing MSI at several loci (MSI-H). Both insertions and deletions were evident and occasional intratumour heterogeneity was evident with more than one different additional allele in the tumour. Most MSI-H tumours had acquired mutations in more than one gene and longer repeated sequences were more frequently targets for mutations. The TGFbetaIIR gene was mutated in 62%, the hMSH3 gene in 43%, the E2F4 gene in 35%, the hMSH6 in 32%, the BAX gene in 32%, the IGFIIR gene in 26%, and the BRCA2 gene in 2% of the MSI-H tumours. Homozygous mutations or mutation of both alleles were evident in all genes except BRCA2, in total 23/105 mutated cases, varying from 7% for BAX to 50% for E2F4. E2F4 mutations were exclusively found in colon tumours and E2F4 polymorphisms was found in 8% of cases. No difference in mutation prevalence was noted between cancer types apart from TGFbetaIIR mutations, which were frequently found in colon and gastric tumours but not in endometrial tumours, suggesting that endometrial tumours progress by a different route where TGFbetaIIR mutations are less favourable.

[How much is the workload of surgeons in Scandinavia?]

According to figures presented at the Bianniul General Meeting of the Scandinavian Surgical Society, the mean number of operations performed per surgeon at some clinics of different sizes in Denmark, Finland, Iceland, Norway and Sweden ranged from 90 to 240 in 1996. This corresponds to 2.6 to 8.5 hours actual operating time, though figures are misleading since time spent assisting at operations, or on endoscopies, minor diagnostics and outpatient procedures, and essential pre- and post-operative tasks is not included. This level of operative activity is considered barely sufficient for training surgeons or for maintaining surgical skills. Surgeons could devote more time to surgery if a greater proportion of their non-surgical workload was taken over by other hospital staff, which would also reduce the number of surgeons required.

Jaw lift--a simple and effective method to open the airway in children

Assessment of breathing during resuscitation of children is important. Misjudgement due to failure to open the airway may lead to mouth-to-mouth ventilation in unconscious children who have retained spontaneous breathing efforts, and might lead to completely ineffective ventilation with gastric distension. The efficiency of the standard head tilt-chin lift manoeuvre (HT-CL) and the jaw lift manoeuvre (JL) for opening of the airway in children was investigated. Fifty children between 1 and 9 years of age breathing spontaneously during deep anaesthesia were studied. Both manoeuvres were randomly performed in all children by nurse anaesthetists. The time for opening and the quality of the airway was determined by a blind folded anaesthesiologist listening to the breathing sounds. The standard HT-CL manoeuvre was insufficient in 12% of the children. JL was more effective than HT-CL in opening the airway in unconscious children who had retained attempts at spontaneous breathing. The JL manoeuvre may, therefore, be recommended in situations when the HT-CL manoeuvre is insufficient.

[Elective splenectomies in Landspítalinn 1985-1994.]

OBJECTIVE

Splenectomy following trauma is well known and the consequences have been investigated thoroughly. Several splenic diseases are treated by simple splenectomy. Furthermore, it may be necessary to do a splenectomy in case of intraoperative splenic trauma. The aim of this study was to investigate the indications for splenectomy in these two groups of patients and to estimate the longterm results.

MATERIAL AND METHODS

We analysed all medical files of patients without history of splenic trauma but who nevertheless underwent splenectomy. We noted clinical features, laboratory findings, complications of the operation, volume of bloodloss and longterm results regarding the primary diagnosis.

RESULTS

In 1985-1994, 93 patients had splenectomy at the former noted occasions. We found medical files for 89 patients. Of them, 36 had disease of the spleen or diseases associated with it (group A) but 53 had no splenic disease (group B). In group A, a great variety of diseases led to splenectomies, idiopathic thrombocytopenic purpura being in the first place (28%) and non Hodgkin's lymphoma in the second place (12%). In group B the most common operation was a gastrectomy due to gastric cancer (30%) but in second place was an operation of the pancreas in connection with pancreas cancer (13%). The most common clinical indications for splenectomy in group A were thrombocytopenia (34%) and abdominal pain because of an enlarged spleen (23%). Intraoperative trauma (49%) of the spleen was the most common indication in group B. Before the operation, 13 patients got glucocorticoid steroids, nine patients received blood transfusions, and six patients got immunoglobulins, all in group A. There was less bloodloss and therefore a lower need for tranfusions in group A. Longterm results in group A, regarding primary disease, were good in 24 patients (67%), tolerable in three (8%), poor in four (11%) but uncertain in five (14%). Perioperative or postopertive complications were minimal. Often the results of splenectomies are good in patients with splenic diseases and these operations are quite safe.

CONCLUSIONS

Longterm results are strongly connected with the underlying disease. With greater attention and care we suppose the incidence of splenectomies could be lowered in patients without splenic disease.

[Laparoscopic Cholecystectomy at Landspítalinn, University Hospital of Iceland. The first 353 cases.]

OBJECTIVE

Since the first laparoscopic cholecystectomy done at the Department of Surgery in November 1991, our aim has been to operate on all presenting patients by this method.

MATERIAL AND METHODS

From November 17th 1991 until September 30th 1994, 384 cholecystectomies were performed. Open cholecystectomy was performed in 31 patients. The most frequent causes for open operation were; suspected stones in the choledochus, acute cholecystitis or biliary sepsis. The objective of this study was to determine the frequency of procedure-related complications and the frequency of conversion to open surgery. Furthermore, the operation time, the length of post-operative hospital stay, mortality and morbidity were studied.

RESULTS

A retrospective analysis of patients undergoing cholecystectomy during this period was performed. Post-operatively patients were also contacted by telephone. There were 121 males and 263 females, ranging between three and 91 year of age. Mean age was 53.2 years. Urgent operations (operation performed after emergency admission) were 43.9%, being highest in the last period of the study. Conversion to open surgery was needed in 63 cases (17.8%). The reasons were; adhesions (39.7%), unclear anatomy (17%) and bleeding (15.9%). Conversion rate was 13% for elective operations but 24% for acute cases. Reoperation was needed in 11 cases (3.8%). Seven patients were reoperated during the same hospital admission but four later on. The reasons were; bleeding (four), bile leakage (three), common duct stone (two), subphrenic abscess (one) and injury to the common bile duct (one). One patient (83 years old male) died of pulmonary embolus after a converted operation. The mean operation time for laparoscopic cholecystectomy was 94.9 minutes (30-210 minutes). For the first 100 operations the mean operative time was 99.3 minutes but 85.5 minutes for the last 100. The mean hospital stay after laparoscopic cholecystectomy was 3.1 days (ranging from just few hours to 60 days). Data on 257 patients after laparoscopic cholecystectomy showed that the mean loss of work or preoperative activity level was 17.6 days (2-87 days). There was a statistically significant difference between preoperative activity level in the emergency versus the elective group (21.4 or 15 days, p<0.05).

CONCLUSIONS

We conclude that laparoscopic cholecystectomy is a safe procedure and its safety will increase as surgeons gain more experience. Furthermore, this technique may be recommended for elective and emergency cases. Shorter hospital stay and fewer working days lost, followed by decreased expenses both for the patient as well as the community as a whole, must also be considered as a major advantage.

[Peptic ulcer perforations, University Hospital of Iceland 1989-1995.]

OBJECTIVE

In this audit we looked at patients who came in to the University Hospital of Iceland, diagnosed to have perforated peptic ulcer, with the aim to gain information about the patients and the treatment.

MATERIAL AND METHODS

Information was from patients' notes, of 72 patients presenting with perforated peptic ulcer, from 1 January 1989 to 31 December 1995. Mean age of patients was 59 years. Male: female 1:1.

RESULTS

Twenty nine persent of the patients had history of previous peptic ulcer. One third of the patients were receiving NSAID at the time of perforation, 54% had gastric perforation and 45% duodenal perforation. Fourty four (64%) did undergo laparotomy and 25 (36%) laparoscopy. Of the 25, 11 operations were converted to laparotomy. Mortality was 13%. Patients, that had laparoscopic treatment, were discharged 2.3 days earlier on average, compared to those undergoing laparotomy. Thirty one (45%) patients had concomitant disease(s).

CONCLUSIONS

A large proportion of patients coming to hospital with perforated peptic ulcers are older people, many with serious concomitant diseases. Laparoscopic treatment of perforated ulcers are equal to lapotomy, altough laporoscopic treatment shows a trent towards shortening of postoperative treatment in hospital.