Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022

INTRODUCTION

Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status.

AIM

To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques.

MATERIALS AND METHODS

Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden.

RESULTS

In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001).

CONCLUSIONS

All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.

Characterization of synaptic structural plasticity in mouse spinal dorsal horn neurons

Here, we present a pipeline for the characterization of synaptic structural plasticity in mouse spinal dorsal horn (SDH) neurons. We describe steps for the intra-SDH microinjection of the EGFP virus to sparsely label L4 SDH neurons without laminectomy, wide dynamic range neuron imaging, dendritic spine morphometric analysis, and F-actin to G-actin ratio measurement. This protocol can be applied to investigate the synaptic structural plasticity mechanisms in the SDH as well as in the brain. For complete details on the use and execution of this protocol, please refer to Li et al. (2023).1.

Laser-Particle Collider for Multi-GeV Photon Production

As an alternative to Compton backscattering and bremsstrahlung, the process of colliding high-energy electron beams with strong laser fields can more efficiently provide both a cleaner and brighter source of photons in the multi-GeV range for fundamental studies in nuclear and quark-gluon physics. In order to favor the emission of high-energy quanta and minimize their decay into electron-positron pairs, the fields must not only be sufficiently strong, but also well localized. We here examine these aspects and develop the concept of a laser-particle collider tailored for high-energy photon generation. We show that the use of multiple colliding laser pulses with 0.4 PW of total power is capable of converting more than 18% of multi-GeV electrons passing through the high-field region into photons, each of which carries more than half of the electron initial energy.

Sustainability of the relationship between preoperative symptoms and postoperative improvement in quality of life after inguinal hernia repair

PURPOSE

Chronic pain and discomfort are common before and after inguinal hernia repair (IHR) and pain is clearly linked to reduced quality of life (QoL). The long-term effect of IHR on QoL in relation to preoperative symptoms is incompletely described.

METHODS

309 men (18-75 years) undergoing IHR under local anesthesia and day care surgery were included. Pre- and postoperative symptoms, pain and QoL (SF-36) were measured before and up to 3 years after surgery.

RESULTS

Before surgery, 197 patients (64%) reported pain (VAS 0.9-5.4) from their inguinal hernia. 102 patients (33%) had other inguinal symptoms, and 26% were asymptomatic. Patients with preoperative groin pain (P) scored their physical QoL (PCS) lower compared with controls (C) (median (IQR) 43.5 (34.7-50.3) vs. 53.9 (47.8-56.9, p < 0.001)), whereas patients with no pain (N) did not (53.0 (47.9-55.9), p = 0.57). Mental QoL was not affected before or after surgery. At 1, 2 and 3 years after surgery, 14, 12 and 7% of patients, respectively, reported groin pain. In P, PCS increased from 43.5 before surgery to 55.3 (p < 0.001) at 36 months, but was unchanged in N (53.0 vs 55.9, p = ns).

CONCLUSIONS

The incidence of inguinal pain decreases over time after inguinal hernia repair. Both preoperative reduction and long-term improvement in physical QoL are strongly associated with the presence of preoperative groin pain. This supports, from a QoL perspective, that patients with preoperative pain are those who benefit the most from IHR, also from a long-term perspective.

Rates of and methods used at reoperation for recurrence after primary inguinal hernia repair with Prolene Hernia System and Lichtenstein

Introduction

Since the introduction of tension-free mesh repair of inguinal hernia ad modum Lichtenstein (L), recurrence rates have been reduced to 1–2%. The bi-layer mesh Prolene Hernia System (PHS) is an alternative mesh with a theoretical potential to further reduce recurrence rates. However, a reoperation due to recurrence after PHS might be technically difficult since both the anterior and posterior space has been utilized.

Methods

Data on all males 18–75 years undergoing primary inguinal hernia repair (IHR) with PHS or L between January 1999 and October 2010 was collected from the Swedish Hernia Register (SHR). Moreover, data was collected for all operations due to recurrence after primary IHR with PHS or L between January 1st 1999 and December 31st 2014.

Results

A total of 1229 primary IHR with PHS and 78,230 with L was identified. Rates of reoperation for recurrence after PHS was significantly lower compared to L (1.5 vs. 2.7 %), [OR 0.38 (0.20–0.74)]. A medial recurrence was most common in both groups. At reoperation, an open anterior mesh repair was used in 74 % after PHS and a posterior mesh repair was performed in 58 % after L. Re-operating time was shorter, although not statistically significant in the PHS group (47 vs. 58 min, p = 0.29). Complication rates after surgery due to recurrence did not differ between groups.

Conclusion

The findings from this dataset suggest that recurrence rates after primary IHR with PHS might be lower and that reoperation due to recurrence after PHS is not more complicated than after L.

Age at adiposity rebound and body mass index trajectory from early childhood to adolescence; differences by breastfeeding and maternal immigration background

OBJECTIVE

This paper aims to assess association between breastfeeding and maternal immigration background and body mass index development trajectories from age 2 to 16 years.

METHODS

A cohort of children born in Stockholm during 1994 to 1996 was followed from age 2 to 16 years with repeated measurement of height and weight at eight time points (n = 2278). Children were categorized into groups by breastfeeding status during the first 6 months of life and maternal immigration background. Body mass index (BMI) trajectories and age at adiposity rebound were estimated using mixed-effects linear models.

RESULTS

Body mass index trajectories were different by breastfeeding and maternal immigration status (P-value < 0.0001). Compared with exclusively breastfed counterparts, never/short breastfed children of Swedish mothers had a higher BMI trajectory, whereas never/short breastfed children of immigrant mothers followed a lower BMI trajectory. Ages at adiposity rebound were earlier for higher BMI trajectories regardless of maternal immigration background.

CONCLUSION

Differences in BMI trajectories between offspring of immigrant and of Swedish mothers suggest a lack of beneficial association between breastfeeding and long-term BMI development among children of immigrant mothers. Given the relation between long-term BMI development and risk of overweight/obesity, these differences challenge the notion that exclusive breastfeeding is always beneficial for children's BMI development and subsequent risk of overweight/obesity.

UltraPro Hernia System, Prolene Hernia System and Lichtenstein for primary inguinal hernia repair: 3-year outcomes of a prospective randomized controlled trial

PURPOSE

Chronic pain and discomfort are common after inguinal hernia repair (IHR). In this study, results from a 3-year follow-up from a randomized controlled study comparing three different mesh repairs for postoperative pain, discomfort, Quality of Life (QoL) and patient satisfaction are reported.

METHODS

Between November 1, 2006 and January 31, 2009, 309 men, who underwent day surgery for primary unilateral inguinal hernia under local anesthesia, were randomized to three different mesh repairs; UltraPro Hernia System (U), Prolene Hernia System (P) and Lichtenstein procedure (L).

RESULTS

Preoperatively, there were no differences between groups regarding demographics, symptoms, inguinal pain or QoL (SF-36 and a hernia-specific questionnaire). Operating time, postoperative pain, complications and time to full recovery were similar. At 36 months, 21 patients indicated pain [L, n = 6, P, n = 6 and U, n = 9; VAS (median (IQR)): L 0.4 (0.2-1.7), P 0.2 (0.1-2.3) and U 1.6 (0.7-4.6), p = ns]. Physical QoL was reduced in all groups before surgery and was similarly increased to normal levels after 3 months without further changes throughout the study. Although 92 % of participants were satisfied, sixteen percent reported any discomfort from the groin (ns between groups). Five recurrences were reported (L, n = 2, P, n = 1 and U, n = 2, p = ns).

CONCLUSIONS

After 3 years of follow-up, all three procedures provided equally good results regarding, pain, discomfort and QoL and could therefore be recommended for primary IHR in LA.

Incidence of Hepatitis E Antibodies in Swedish Lung Transplant Recipients

BACKGROUND

Hepatitis E virus (HEV) is an important cause of acute and chronic hepatitis in solid organ transplant recipients, especially liver transplant recipients. However, less is known of the incidence and prevalence of HEV in lung transplant recipients.

METHODS

In a prospective study, 62 patients were observed during the first year after lung transplantation. Sera were analyzed for anti-HEV immunoglobulin G (IgG) and IgM at 12 months after transplantation. Samples positive for anti-HEV were also analyzed for HEV RNA by polymerase chain reaction. Pretransplantation samples were analyzed for patients with detectable anti-HEV 1 year after transplantation.

RESULTS

Eight patients (13%) had anti-HEV IgG at the 12-month follow-up sample. HEV RNA could not be detected in any of these samples. One of these patients seroconverted during the follow-up without developing acute or chronic hepatitis.

CONCLUSIONS

Our results show that the prevalence of HEV antibodies among Swedish lung transplant recipients is similar when compared to the general population. It also suggests that the risk for HEV antibody seroconversion during first year is limited.

Maternal body mass index in early pregnancy and offspring asthma, rhinitis and eczema up to 16 years of age

Background

Maternal obesity has been linked to offspring asthma; however, other allergy-related diseases, as well as the association beyond early school age, are largely unstudied.

Objective

To examine the associations between maternal body mass index (BMI) in pregnancy and offspring asthma, rhinitis, eczema and sensitization up to 16 years of age.

Methods

A total of 3294 children from the Swedish birth cohort BAMSE were included in the analyses. Maternal BMI was assessed around week 10 in pregnancy. Information on asthma, rhinitis, eczema, lifestyle factors and environmental exposures was obtained by parental questionnaires at 1, 2, 4, 8, 12 and 16 years. Sensitization was defined from IgE levels of inhalant allergens at 4, 8 and 16 years in a subsample of 2850 children. Generalized estimated equation models were used to analyse the associations between maternal BMI and the outcomes at 1–16 years.

Results

Maternal BMI was positively associated with overall risk of asthma up to age of 16 years (adj OR per 5 kg/m² increase: 1.23; 95% CI 1.07–1.40 for prevalent asthma) excluding underweight mothers. In contrast, no significant associations were found for rhinitis, eczema or sensitization. The association with asthma was restricted to obese, rather than overweight mothers, but was attenuated when adjusting for overweight in the offspring. A causal inference test at 16 years further indicated that the child’s own overweight is a mediator in the suggested association between maternal BMI and offspring asthma at 16 years.

Conclusions and Clinical Relevance

Maternal BMI is associated with an increased risk of asthma, but not rhinitis, eczema or sensitization; however, overweight in the offspring seems to have a mediating role. Prevention strategies of maternal pre-pregnancy and childhood obesity might be important to reduce the prevalence of childhood asthma.

Plasticity in breathing and arterial blood pressure following acute intermittent hypercapnic hypoxia in infant rat pups with a partial loss of 5-HT neurons

The role of serotonin (5-HT) neurons in cardiovascular responses to acute intermittent hypoxia (AIH) has not been studied in the neonatal period. We hypothesized that a partial loss of 5-HT neurons would reduce arterial blood pressure (BP) at rest, increase the fall in BP during hypoxia, and reduce the long-term facilitation of breathing (vLTF) and BP following AIH. We exposed 2-wk-old, 5,7-dihydroxytryptamine-treated and controls to AIH (10% O2; n = 13 control, 14 treated), acute intermittent hypercapnia (5% CO2; n = 12 and 11), or acute intermittent hypercapnic hypoxia (AIHH; 10% O2, 5% CO2; n = 15 and 17). We gave five 5-min challenges of AIH and acute intermittent hypercapnia, and twenty ∼20-s challenges of AIHH to mimic sleep apnea. Systolic BP (sBP), diastolic BP, mean arterial pressure, heart rate (HR), ventilation (V̇e), and metabolic rate (V̇o2) were continuously monitored. 5,7-Dihydroxytryptamine induced an ∼35% loss of 5-HT neurons from the medullary raphe. Compared with controls, pups deficient in 5-HT neurons had reduced resting sBP (∼6 mmHg), mean arterial pressure (∼5 mmHg), and HR (56 beats/min), and experienced a reduced drop in BP during hypoxia. AIHH induced vLTF in both groups, reflected in increased V̇e and V̇e/V̇o2, and decreased arterial Pco2. The sBP of pups deficient in 5-HT neurons, but not controls, was increased 1 h following AIHH. Our data suggest that a relatively small loss of 5-HT neurons compromises resting BP and HR, but has no influence on ventilatory plasticity induced by AIHH. AIHH may be useful for reversing cardiorespiratory defects related to partial 5-HT system dysfunction.

Genome-wide association study of body mass index in 23 000 individuals with and without asthma

BACKGROUND

Both asthma and obesity are complex disorders that are influenced by environmental and genetic factors. Shared genetic factors between asthma and obesity have been proposed to partly explain epidemiological findings of co-morbidity between these conditions.

OBJECTIVE

To identify genetic variants that are associated with body mass index (BMI) in asthmatic children and adults, and to evaluate if there are differences between the genetics of BMI in asthmatics and healthy individuals.

METHODS

In total, 19 studies contributed with genome-wide analysis study (GWAS) data from more than 23 000 individuals with predominantly European descent, of whom 8165 are asthmatics.

RESULTS

We report associations between several DENND1B variants (P = 2.2 × 10(-7) for rs4915551) on chromosome 1q31 and BMI from a meta-analysis of GWAS data using 2691 asthmatic children (screening data). The top DENND1B single nucleotide polymorphisms(SNPs) were next evaluated in seven independent replication data sets comprising 2014 asthmatics, and rs4915551 was nominally replicated (P < 0.05) in two of the seven studies and of borderline significance in one (P = 0.059). However, strong evidence of effect heterogeneity was observed and overall, the association between rs4915551 and BMI was not significant in the total replication data set, P = 0.71. Using a random effects model, BMI was overall estimated to increase by 0.30 kg/m(2) (P = 0.01 for combined screening and replication data sets, N = 4705) per additional G allele of this DENND1BSNP. FTO was confirmed as an important gene for adult and childhood BMI regardless of asthma status.

CONCLUSIONS AND CLINICAL RELEVANCE

DENND1B was recently identified as an asthma susceptibility gene in a GWAS on children, and here, we find evidence that DENND1B variants may also be associated with BMI in asthmatic children. However, the association was overall not replicated in the independent data sets and the heterogeneous effect of DENND1B points to complex associations with the studied diseases that deserve further study.

Time- and age-dependent effects of serotonin on gasping and autoresuscitation in neonatal mice

The role of brain stem serotonin (5-hydroxytryptamine, 5-HT) in autoresuscitation in neonatal life is unclear. We hypothesized that a specific loss of 5-HT would compromise gasping and autoresuscitation mainly in the second postnatal week and that acute restoration of 5-HT would reverse the defects. We exposed postnatal day (P)4-5, P8-9, and P11-12 tryptophan-hydroxylase-2 knockout (TPH2(-/-)) and wild-type littermates (WT) to 10 episodes of anoxia (97% N2, 3% CO2), measuring survival, gasp latency, gasp frequency (fB), and the time required to restore eupnea and heart rate. We also tested P8-9 TPH2(-/-) mice after restoring 5-HT with a single injection of 5-hydroxytryptophan (5-HTP) 1-2 h before testing or with multiple injections beginning 24 h before testing. At P4-5 and P8-9, but not at P11-12, gasp latency and the recovery of eupnea were delayed ~2- to 3-fold in TPH2(-/-) pups compared with WT (P < 0.001). At all ages, TPH2(-/-) pups displayed reduced gasp fB (~20-30%; P < 0.001) and delayed heart rate recovery (~60%; P = 0.002) compared with WT littermates. TPH2(-/-) survival was reduced compared with WT (P < 0.001), especially at P8-9 and P11-12 (P = 0.004). Whereas 1-2 h of 5-HTP treatment improved the gasp latency and fB of P8-9 TPH2(-/-) pups, improved cardiorespiratory recovery and survival required 24 h of treatment. Our data suggest that 5-HT operates over a long time span (24 h) to improve survival during episodic severe hypoxia. Early in development (P4-9), 5-HT is critical for both respiratory and cardiovascular components of autoresuscitation; later (P11-12), it is critical mainly for cardiovascular components. Nevertheless, the effect of 5-HT deficiency on survival is most striking from P8 to P12.

Antioxidant intake and allergic disease in children

BACKGROUND

Antioxidant intake may reduce the risk of allergic disease by protecting against oxidative tissue damage. Major sources of antioxidants in the Western world are fruits, vegetables (vitamin C, β-carotene, α-tocopherol), meat and milk (selenium, magnesium, zinc). Children may exclude or eat less of some fruits and vegetables due to cross-reactivity between pollen and these foods, complicating assessment of causal relationships.

OBJECTIVE

To investigate the association between dietary antioxidant intake and allergic disease, taking potential reverse causation into account.

METHODS

Data on 2442 8-year-old children from the Swedish birth cohort study BAMSE were analysed. Children with completed parental questionnaires on exposures and health, including a food-frequency questionnaire and who provided a blood sample were included. Associations between antioxidant intake during the past year and current allergic disease were analysed using logistic regression.

RESULTS

An inverse association was observed between intake of β-carotene and rhinitis (OR(adj), highest vs. lowest quartile, 0.67, 95% CI 0.49-0.93). Magnesium intake was inversely related to asthma (OR(adj), 0.65, 95% CI 0.42-1.00) and atopic sensitisation (OR(adj), 0.78, 95% CI 0.61-1.00). Following exclusion of children who avoided certain fruits, vegetables or milk due to allergic symptoms (n = 285), the inverse association remained between magnesium intake and asthma (OR(adj), 0.58, 95% CI 0.35-0.98), whereas all other associations became non-significant.

CONCLUSION AND CLINICAL RELEVANCE

Diet modifications due to allergy may affect the antioxidant intake and needs to be considered when investigating the relationship between diet and allergic disease. Magnesium intake seems to have a protective effect on childhood asthma.

Novel molecular platform integrated iron chelation therapy for 1H-MRI detection of β-galactosidase activity

Targeting the increased Fe(3+) content in tumors, we propose a novel molecular platform integrated cancer iron chelation therapy for (1)H-magnetic resonance imaging (MRI) detection of β-galactosidase (β-gal) activity. Following this idea, we have designed, synthesized, and characterized a series of β-d-galactosides conjugated with various chelators and demonstrated the feasibility of this concept for assessing β-gal activity in solution by (1)H-MRI T1 and T2 relaxation mapping.

Bottom trawling resuspends sediment and releases bioavailable contaminants in a polluted fjord

Sediments are sinks for contaminants in the world's oceans. At the same time, commercial bottom trawling is estimated to affect around 15 million km(2) of the world's seafloor every year. However, few studies have investigated whether this disturbance remobilises sediment-associated contaminants and, if so, whether these are bioavailable to aquatic organisms. This field study in a trawled contaminated Norwegian fjord showed that a single 1.8 km long trawl pass created a 3-5 million m(3) sediment plume containing around 9 t contaminated sediment; ie. 200 g dw m(-2) trawled, equivalent to c. 10% of the annual gross sedimentation rate. Substantial amounts of PCDD/Fs and non-ortho PCBs were released from the sediments, likely causing a semi-permanent contaminated sediment suspension in the bottom waters. PCDD/Fs from the sediments were also taken up by mussels which, during one month, accumulated them to levels above the EU maximum advised concentration for human consumption.

Comparison of optical and power Doppler ultrasound imaging for non-invasive evaluation of arsenic trioxide as a vascular disrupting agent in tumors

Small animal imaging provides diverse methods for evaluating tumor growth and acute response to therapy. This study compared the utility of non-invasive optical and ultrasound imaging to monitor growth of three diverse human tumor xenografts (brain U87-luc-mCherry, mammary MCF7-luc-mCherry, and prostate PC3-luc) growing in nude mice. Bioluminescence imaging (BLI), fluorescence imaging (FLI), and Power Doppler ultrasound (PD US) were then applied to examine acute vascular disruption following administration of arsenic trioxide (ATO).

During initial tumor growth, strong correlations were found between manual caliper measured tumor volume and FLI intensity, BLI intensity following luciferin injection, and traditional B-mode US. Administration of ATO to established U87 tumors caused significant vascular shutdown within 2 hrs at all doses in the range 5 to 10 mg/kg in a dose dependant manner, as revealed by depressed bioluminescent light emission. At lower doses substantial recovery was seen within 4 hrs. At 8 mg/kg there was >85% reduction in tumor vascular perfusion, which remained depressed after 6 hrs, but showed some recovery after 24 hrs. Similar response was observed in MCF7 and PC3 tumors. Dynamic BLI and PD US each showed similar duration and percent reductions in tumor blood flow, but FLI showed no significant changes during the first 24 hrs.

The results provide further evidence for comparable utility of optical and ultrasound imaging for monitoring tumor growth, More specifically, they confirm the utility of BLI and ultrasound imaging as facile assays of the vascular disruption in solid tumors based on ATO as a model agent.

Adolescent multiple risk behaviour: an asset approach to the role of family, school and community

BACKGROUND

Engagement in risk behaviours may pose a significant threat to health if involvement spans multiple behaviours. The asset model suggests that contextual aspects of young people's lives, such as factors related to family, school and community, serve as a protective function against health risk behaviours.

METHODS

A risk-taking index was created from the English health behaviour in school-aged children study on 15 years olds, substance use and sexual activity. Using a multinomial regression, potential asset variables relating to school, family, peers, community and family affluence were tested for their association with levels of risk behaviours.

RESULTS

Sense of neighbourhood belonging, strong school belonging and parental involvement in decision-making about leisure time were related to lower engagement in health risk behaviours. A weaker sense of family belonging was associated with increased risk behaviours if connectedness with teachers was also low. Factors related to school and community played a greater role in adolescent participation in health-related risk behaviours than family-related factors, including family affluence.

CONCLUSIONS

Feelings of safety and belonging in the out-of-home settings of adolescents were positively associated with reduced risk behaviours, and indicate the importance of the wider community alongside parents and school as protective assets for health.

Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies

Evidence is increasingly pointing towards the importance of early life strategies to prevent childhood overweight and obesity. This systematic review synthesizes qualitative research concerning parental perceptions regarding behaviours for preventing overweight and obesity in young children. During May and June 2008, a range of electronic databases were searched and together with lateral searching techniques 21 studies were identified for review. Data extraction and synthesis using thematic content analysis revealed six organizing and 32 finer level themes. These related to child factors, family dynamics, parenting, knowledge and beliefs, extra-familial influences and resources and environment. Themes were mapped to a socioecological model which illustrated how factors at individual, interpersonal, community, organizational and societal levels interact in complex ways to impact on parental perceptions about healthy behaviours for preventing child overweight. Although parents suggested several ideas to promote healthy child weight-related behaviours, many of their views concerned perceived barriers, some of which may be amenable to practical intervention. Furthermore, intergenerational influences on parental health beliefs and knowledge suggest that health promotion strategies may be more effective if directed at the wider family, rather than parents alone. Significantly, many parents believed strategies to promote healthy weight should start early in a child's life.

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.