We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.
Altogether 2,120 patients have been enrolled in the Norwegian Cholecystectomy Registry during the first 18 months after it was established. 1,699 patients (80%) were operated on laparoscopically. In 174 (10.2%) the operation was changed to an open procedure. 421 (20%) were operated on primarily using an open technique. The main quality problems were mortality (1.2%) and injuries of the common bile duct (0.95%) associated with open cholecystectomy. These frequencies are far above the values stated in available literature, and two interpretations are possible: Only the best results tend to be published internationally, and our results may be representative for the national average frequencies of serious complications in other countries too. On the other hand, the present results may disclose inadequate quality insufficiency and a need for improvement. The possible actions seem to be: Firstly, to try harder to avoid open cholecystectomy in seriously ill patients (ASA 3-4). If possible, they should not be operated on at all. When surgery is essential, a laparoscopic technique seems to cause less cardiopulmonary complications. Secondly, an improved dissection technique in open (and laparoscopic) surgery is necessary in order to reduce the frequency of injuries of the common bile duct.
Comment In: Tidsskr Nor Laegeforen. 1995 Sep 10;115(21):2694-57570484
A high autopsy rate is a requirement for confirming or correcting clinical diagnoses and for providing opportunities for medical education on pre- and postgraduate level. A telephone survey was conducted to obtain information about the opinion of the Norwegian public on this matter. A randomised sample of 1,050 persons over 15 years of age were asked whether they would consent to autopsy if a close family member died in a hospital. Of the 954 (91%) who agreed to answer, 86% (95% CI 84-89) would consent, while 14% (95% CI 11-16) were unsure or would object. Demographical background variables did not significantly influence the response. When asked if they would give prior consent to an autopsy on themselves, should they die in a hospital, 84% (95% CI 82-87) said they would agree, while 16% (95% CI 13-18) were unsure or would object. Age between 31-50 years, male sex and married civil status significantly increased the likelihood of a positive attitude towards autopsy. The survey revealed a generally favourable attitude in the population towards autopsy. This positive confidence has to be maintained through careful talks with relatives about autopsy, and arrangements for relatives to be informed of the result of an autopsy.