The 65 reports of accidental lesions of the choledochus at cholecystectomy from the records of the Patients' Insurance Syndicate in Stockholm, Sweden, 1975-1982, were studied in order to characterize avoidable factors and/or situations at cholecystectomy. Compared with control materials, there were significantly less men (28 vs. 34%) and the patients were younger (46 vs. 54 years). The patients were without significant other diseases and former operations, and were slim or of a normal weight. The patients had a short history of known biliary tract disease and there was seldom a suspicion of common duct stone. Most of the surgeons were under training and 80% of them had done 25 to 100 cholecystectomies before, seldom assisted by a more experienced surgeon. The inflammation was never severe, the bleeding insignificant, and an anomaly was found after the lesion was done in only 16 of 55 cases. The lesion was done before cholangiography in 27 cases and after the cholangiography, but before the films were available in 32 cases. The gallbladder was excised about as often from the fundus as from the pouch. We have found it probable that most of these accidental injuries of the choledochus could have been prevented with a policy that considers cholecystectomy as a major operation that requires well-trained surgeons with a humble and concentrated approach to their task.
BACKGROUND: Studies on the incidence and etiology of acute pancreatitis show large regional differences. This study was performed to establish incidence, etiology and severity of acute pancreatitis in the population of Bergen, Norway. METHODS: A study of all patients with acute pancreatitis admitted to Haukeland University Hospital over a 10-year period was performed. Information was obtained about the number of patients with acute pancreatitis admitted to the Deaconess Hospital in Bergen. RESULTS: A total of 978 admissions of acute pancreatitis were recorded in these two hospitals giving an incidence of 30.6 per 100,000. Haukeland University Hospital had 757 admissions of acute pancreatitis in 487 patients. Pancreatitis was severe in 20% (96/487) of patients, more often in males (25%) than in females (14%). Mortality due to acute pancreatitis was 3% (16/487). Gallstones were found to be an etiological factor in 48.5% and alcohol consumption in 19% of patients. The risk of recurrent pancreatitis was 47% in alcohol induced and 17% in gallstone induced pancreatitis. The last five years of the study period, endoscopic sphincterotomy of patients with gallstone pancreatitis, resulted in drop in relapse rate from 33% to 1.6%. CONCLUSION: The incidence of acute pancreatitis was found to be 30.6 per 100,000 with 48.5% associated with gallstones and 17% alcohol induced. Incidence of first attack was 20/100,000. Pancreatitis was classified as severe in 20% of cases with a mortality of 3%.
The incidence during the last decades of acute appendicitis and the number of appendicectomies in the elderly, 60 years of age and older were studied. In addition, the incidence of the disease and of appendicectomy and the preoperative findings were studied in a well defined population during the twelve year period from 1969 to 1980. The results showed that there was no increase in the sex- and age-specific incidence of acute appendicitis in the elderly. However, there has been a significant decrease in the incidence of acute appendicitis in the elderly during the last four decades. Furthermore, a significant difference was found in the findings in the elderly operated upon because of suspected acute appendicitis compared to the younger age groups. The percentage of perforated appendices and normal appendices was significantly higher in the elderly. This difference might be of importance to the surgeon in his approach to an elderly patient admitted because of suspected acute appendicitis.
Acute appendicitis is common but the aetiology is unclear. This study examined the heritability of acute appendicitis.
The study included twin pairs with known zygosity born between 1959 and 1985. Individuals with acute appendicitis were found by record linkage with the Swedish Inpatient Register. Comparing monodizygotic and dizygotic twins, the similarity and relative proportions of phenotypic variance resulting from genetic and environmental factors were analysed. Risks of acute appendicitis explained by heritability and environmental effects were estimated.
Some 3441 monozygotic and 2429 dizygotic twins were identified. Almost no genetic effects were found in males (8 (95 per cent confidence interval 0 to 50) per cent), but shared (31 (0 to 49) per cent) and non-shared (61 (47 to 74) per cent) environmental factors accounted for this risk. In females, the heritability was estimated as 20 (0 to 36) per cent and the remaining variation was due to non-shared environmental factors (80 (64 to 98) per cent). For the sexes combined, genetic effects accounted for 30 (5 to 40) per cent and non-shared environmental effects for 70 (60 to 81) per cent of the risk.
Acute appendicitis has a complex aetiology with sex differences in heritability and environmental factors.
OBJECTIVE: Evaluation of incidence and outcome of implantation metastases after percutaneous fine-needle biopsy or biliary drainage. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: Eight patients with implantation metastases from gastrointestinal cancers after percutaneous fine-needle biopsy (n = 7) or biliary drainage (n = 1). MAIN OUTCOME MEASURES: Incidence of implantation metastases, treatment and influence on outcome and survival. RESULTS: In two out of three patients who had had otherwise radical operations, the implantation metastases meant that the operations were palliative rather than curative. Patients who had had palliative resections of the implantation metastases developed major local complications. One patient is alive with no signs of disease after 106 months, while one is alive with disease 30 months after the diagnosis of the implantation metastases. The remaining patients have died after 6 to 23 months. CONCLUSION: The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Implantation metastases cause local complaints of varying severity and seems to have a tendency to recur locally. We recommend that fine-needle biopsy should be restricted to patients who will truly benefit from a more accurate preoperative diagnosis.