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Adverse effects of delayed treatment for perforated peptic ulcer.

https://arctichealth.org/en/permalink/ahliterature217583
Source
Ann Surg. 1994 Aug;220(2):168-75
Publication Type
Article
Date
Aug-1994
Author
C. Svanes
R T Lie
K. Svanes
S A Lie
O. Søreide
Author Affiliation
Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Source
Ann Surg. 1994 Aug;220(2):168-75
Date
Aug-1994
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Bacterial Infections - epidemiology
Cause of Death
Duodenal Ulcer - complications - surgery
Female
Follow-Up Studies
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Norway - epidemiology
Odds Ratio
Peptic Ulcer Perforation - complications - mortality - surgery
Postoperative Complications - epidemiology
Risk factors
Stomach Ulcer - complications - surgery
Survival Rate
Time Factors
Treatment Outcome
Abstract
The authors assessed the consequences of delayed treatment for ulcer perforation with regard to short-term and long-term survival, complication rates, and length of hospital stay.
Important adverse effects of delayed treatment have not been studied previously. Conflicting results have been given with regard to short-term survival.
One thousand two hundred ninety-two patients operated on for perforated peptic ulcer in the Bergen area between 1935 and 1990 were studied. The effect of delay on postoperative lethality and complications adjusted for age, sex, ulcer site, and year of perforation was analyzed by stepwise logistic regression. The effect of delay on duration of hospital stay adjusted for potential confounding factors was analyzed by Cox proportional hazards regression. Observed survival was estimated by the Kaplan-Meier method, and expected survival was calculated from population mortality data.
Adverse effects increased markedly when delay exceeded 12 hours. Delay of more than 24 hours increased lethality sevenfold to eightfold, complication rate to threefold, and length of hospital stay to twofold, compared with delay of 6 hours or less. The reduced long-term survival for patients treated more than 12 hours after perforation could be attributed entirely to high postoperative mortality.
Delayed treatment after peptic ulcer perforation reduced survival, increased complication rates, and caused prolonged hospital stay. To improve outcome after ulcer perforation, an effort should be made to keep delay at less 12 hours, particularly in elderly patients.
Notes
Cites: Surgery. 1968 Apr;63(4):576-855645373
Cites: Can Med Assoc J. 1967 Mar 4;96(9):519-236019350
Cites: Can Med Assoc J. 1971 Aug 7;105(3):263-9 passim5563345
Cites: Am Surg. 1980 Feb;46(2):61-67369630
Cites: Tidsskr Nor Laegeforen. 1983 Oct 10;103(28):1924-76648928
Cites: Ann Surg. 1987 Jan;205(1):22-63800459
Cites: Surg Clin North Am. 1988 Apr;68(2):315-293279549
Cites: Br J Surg. 1988 Aug;75(8):758-93167522
Cites: Ann Surg. 1989 Apr;209(4):418-232930287
Cites: Br J Surg. 1989 Mar;76(3):215-82720316
Cites: Ann Surg. 1989 Jun;209(6):693-6; discussion 696-72730181
Cites: Zentralbl Chir. 1990;115(8):471-812360374
Cites: Am Surg. 1990 Apr;56(4):270-41973032
Cites: Surg Gynecol Obstet. 1990 Oct;171(4):315-202218836
Cites: Aust N Z J Surg. 1992 May;62(5):338-431575654
Cites: Gut. 1993 Dec;34(12):1666-718282252
Cites: Arch Chir Neerl. 1953;5(4):262-7013140002
Cites: Aust N Z J Surg. 1969 Feb;38(3):243-525251162
PubMed ID
8053739 View in PubMed
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Causes of death in patients with peptic ulcer perforation: a long-term follow-up study.

https://arctichealth.org/en/permalink/ahliterature21222
Source
Scand J Gastroenterol. 1999 Jan;34(1):18-24
Publication Type
Article
Date
Jan-1999
Author
C. Svanes
S A Lie
R T Lie
O. Søreide
K. Svanes
Author Affiliation
Dept. of Surgery, Haukeland Hospital, University of Bergen, Norway.
Source
Scand J Gastroenterol. 1999 Jan;34(1):18-24
Date
Jan-1999
Language
English
Publication Type
Article
Keywords
Cardiovascular Diseases - mortality
Cause of Death
Cohort Studies
Female
Follow-Up Studies
Humans
Lung Diseases, Obstructive - mortality
Male
Mortality - trends
Neoplasms - mortality
Peptic Ulcer Perforation - complications - mortality - surgery
Research Support, Non-U.S. Gov't
Smoking - adverse effects
Abstract
BACKGROUND: Survival is lower in ulcer perforation patients than in the general population. This study assesses the causes of death in patients treated for peptic ulcer perforation. METHODS: Cause-specific mortality in a population-based cohort of 817 patients treated for ulcer perforation in western Norway during the period 1962-1990 was compared with cause-specific population death rates. Analyses were based on observed and expected mortality curves for major causes of death and on standardized mortality rates (SMRs). Cox regression models were used to analyse possible differences on the basis of sex, birth cohort, surgical procedure, and ulcer location. RESULTS: Ulcer perforation patients experienced increased mortality from neoplasms (SMR = 1.8; 95% confidence interval (CI) = 1.4-2.1), lung cancer (SMR = 3.6; 95% CI = 2.3-4.9), circulatory diseases (SMR = 1.3; 95% CI = 1.1-1.6), ischaemic heart disease (SMR = 1.3; 95% CI = 1.03-1.6), and respiratory diseases (SMR = 1.9; 95% CI = 1.3-2.6). Postoperative deaths accounted for 38% of all excess deaths. Death from recurrent peptic ulcer was increased also in subjects who survived the 1st year after the perforation (SMR = 5.8; 95% CI = 1.2-10.4) but accounted for only a few deaths. The increase in mortality from lung cancer was higher in subjects born after 1910 than in patients of older generations. Excess mortality from lung cancer and from circulatory diseases was higher in male than in female patients. CONCLUSIONS: Increased mortality in ulcer perforation patients could mainly be attributed to smoking-related diseases. This is indirect evidence that smoking may be an important aetiologic factor for ulcer perforation.
PubMed ID
10048727 View in PubMed
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Early operation or conservative management of patients with small bowel obstruction?

https://arctichealth.org/en/permalink/ahliterature18661
Source
Eur J Surg. 2002;168(8-9):475-81
Publication Type
Article
Date
2002
Author
B T Fevang
D. Jensen
K. Svanes
A. Viste
Author Affiliation
Department of Surgery, Haukeland University Hospital, University of Bergen, Norway. bjorg.fevang@kir.uib.no
Source
Eur J Surg. 2002;168(8-9):475-81
Date
2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Female
Humans
Intestinal Obstruction - surgery - therapy
Intestine, Small
Male
Middle Aged
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To evaluate the outcome after initial non-operative treatment in patients with small bowel obstruction (SBO). DESIGN: Prospective study. SETTING: University hospital, Norway. PATIENTS: One hundred and fifty-four patients with 166 episodes of SBO admitted during the period (1994-1995). Patients younger than 10 years as well as patients with large bowel obstruction, paralytic ileus, incarcerated hernia or SBO caused by cancer were excluded from the study. INTERVENTIONS: Patients with signs of strangulation were operated on early. The rest were given a trial of conservative treatment. MAIN OUTCOME MEASURES: Need of operative treatment. Incidence of bowel strangulation, complications and death. RESULTS: There were 166 cases of SBO. Twenty patients were operated on early among whom bowel was strangulated in 9. Among the 146 patients initially treated conservatively 93 (64%) settled without operation, 9 (6%) had strangulated bowel and 3 (2%) died. Of the 91 patients with partial obstruction but no sign of strangulation, 72 (79%) resolved on conservative treatment. CONCLUSIONS: Patients with partial obstruction with no sign of strangulation should initially be treated conservatively. When complete obstruction is present, it may settle on conservative management, but the use of supplementary diagnostic tools might be desirable to find the patients who will need early operative treatment.
PubMed ID
12549688 View in PubMed
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Incidence of perforated ulcer in western Norway, 1935-1990: cohort- or period-dependent time trends?

https://arctichealth.org/en/permalink/ahliterature67709
Source
Am J Epidemiol. 1995 May 1;141(9):836-44
Publication Type
Article
Date
May-1-1995
Author
C. Svanes
R T Lie
G. Kvåle
K. Svanes
O. Søreide
Author Affiliation
Department of Surgery, Haukeland University Hospital, University of Bergen, Norway.
Source
Am J Epidemiol. 1995 May 1;141(9):836-44
Date
May-1-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Cohort Effect
Female
Humans
Incidence
Male
Middle Aged
Norway - epidemiology
Peptic Ulcer Perforation - epidemiology - etiology
Prevalence
Research Support, Non-U.S. Gov't
Smoking - epidemiology
Abstract
Previous reports have shown that peptic ulcer mortality follows birth cohorts. To the authors' knowledge, temporal variation in ulcer incidence has not been studied. Therefore, they present incidence data for a defined area of western Norway where 1,312 patients born between 1845 and 1975 were treated for ulcer perforation between 1935 and 1990. A rise and subsequent fall in incidence was observed in successive birth cohorts for both sexes, with the highest incidence observed for males born between 1900 and 1919 and females born between 1920 and 1929. Age-period-cohort analyses based on Poisson regression techniques were adapted to provide a statistical tool for testing specific cohort and period effects. Age-cohort models without period effects explained the variations in incidence for both sexes and all ulcer locations, suggesting cohort-dependent etiology. A cohort pattern in prevalence of smoking partly explained the cohort pattern in perforation risks for both sexes. No period effects were seen that could be attributed to the increase in the sale of non-steroidal anti-inflammatory drugs, to the introduction of antibiotics around 1950, or to World War II. Susceptibility to ulcer perforation seems to follow birth cohorts, and major etiologic factors should be sought in prenatal life, in childhood, or in life-style patterns that follow birth cohorts.
PubMed ID
7717360 View in PubMed
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Morbidity, ability to swallow, and survival, after oesophagectomy for cancer of the oesophagus and cardia.

https://arctichealth.org/en/permalink/ahliterature23102
Source
Eur J Surg. 1995 Sep;161(9):669-75
Publication Type
Article
Date
Sep-1995
Author
K. Svanes
L. Stangeland
A. Viste
J E Varhaug
J E Grønbech
O. Søreide
Author Affiliation
Department of Surgery, University of Bergen, Norway.
Source
Eur J Surg. 1995 Sep;161(9):669-75
Date
Sep-1995
Language
English
Publication Type
Article
Keywords
Adenocarcinoma - surgery
Aged
Carcinoma, Squamous Cell - surgery
Cardia
Deglutition
Esophageal Neoplasms - mortality - surgery
Esophagectomy - mortality
Female
Humans
Length of Stay
Male
Middle Aged
Morbidity
Postoperative Complications
Postoperative Period
Prospective Studies
Stomach Neoplasms - mortality - surgery
Survival Analysis
Abstract
OBJECTIVE: To study survival, morbidity, and ability to swallow, after oesophagectomy for cancer of the oesophagus and cardia. DESIGN: Prospective open study. SETTING: University hospital, Norway. SUBJECTS: 83 patients, 38 with squamous cell carcinoma and 45 with adenocarcinoma of the oesophagus and cardia. INTERVENTIONS: Transhiatal (n = 51) and transthoracic (n = 32) oesophagectomy. Oesophageal replacement was by either stomach (n = 80) or colon (n = 3). Cervical anastomosis was used in all but 2. MAIN OUTCOME MEASURES: Early and late morbidity and mortality, length of stay in intensive care unit and in hospital, and survival analysis. RESULTS: 30 Day and in hospital mortality were 0 and 4% for transhiatal, and 6% and 9% for transthoracic, oesophagectomy. Complications included recurrent nerve palsy (n = 7), anastomotic leaks (n = 5), and chylothorax (n = 4). 17 Patients (22%) needed dilatations for stenosis of the anastomosis, and 71 (85%) of the patients left hospital within four weeks of operation. Survival analysis showed a 5 year survival rate of 33% for patients with adenocarcinoma operated on for cure and a 2 year survival of 28% for patients with squamous cell carcinoma. CONCLUSIONS: Oesophagectomy for cure is worthwhile as some patients are cured and most of the remainder have prolonged relief of their dysphagia. Palliative resections should not be done in patients with distant metastases or invasion of adjacent organs by the tumour because of long stay in hospital, appreciable morbidity, and short life expectancy.
PubMed ID
8541426 View in PubMed
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A multifactorial analysis of factors related to lethality after treatment of perforated gastroduodenal ulcer. 1935-1985.

https://arctichealth.org/en/permalink/ahliterature230984
Source
Ann Surg. 1989 Apr;209(4):418-23
Publication Type
Article
Date
Apr-1989
Author
C. Svanes
H. Salvesen
B. Espehaug
O. Søreide
K. Svanes
Author Affiliation
Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Source
Ann Surg. 1989 Apr;209(4):418-23
Date
Apr-1989
Language
English
Publication Type
Article
Keywords
Duodenal Ulcer - complications - mortality
Female
Humans
Male
Norway
Peptic Ulcer Perforation - mortality - surgery
Regression Analysis
Retrospective Studies
Stomach Ulcer - complications - mortality
Time Factors
Abstract
One thousand one hundred and twenty-eight patients treated for perforated gastroduodenal ulcer during the years 1935-1985 were studied at the Haukeland University Hospital. The majority of patients (97.7%) were treated surgically. The data was analyzed by contingency tables and chi square testing, and a stepwise logistic regression analysis was performed in order to reveal interactions between variables and to elucidate time trends in lethality rates. The total postperforation lethality was 7.4%, the postsurgical death rate was 6.6%, and the death rate among conservatively treated patients was 42.3%. Lethality was significantly influenced by year of hospital admission and increased markedly with the age of the patients. For all age groups, the lethality decreased markedly with time. Treatment delay was associated with a moderate but significant increase in lethality. In patients with gastric ulcer the lethality was 3.6 times higher than in those with duodenal ulcer. The death rate was similar in the duodenal and pyloric ulcer groups. Death rate decreased with time in both stomach ulcer, duodenal, and pyloric ulcer patients. There was no sex difference and no difference between patients treated with simple suture or gastric resection.
Notes
Cites: Am J Surg. 1970 Sep;120(3):306-115456910
Cites: Acta Chir Scand. 1964 Oct;128:406-1314211294
Cites: Ann Surg. 1974 May;179(5):628-334823840
Cites: Br J Surg. 1978 Nov;65(11):801-3719332
Cites: Am Surg. 1980 Feb;46(2):61-67369630
Cites: Ann Surg. 1982 Mar;195(3):265-97059238
Cites: Acta Chir Scand. 1983;149(1):77-816837227
Cites: Tidsskr Nor Laegeforen. 1983 Oct 10;103(28):1924-76648928
Cites: Am J Surg. 1984 Sep;148(3):340-56476224
Cites: Br J Surg. 1984 Oct;71(10):774-66487976
Cites: Arch Surg. 1987 May;122(5):555-613579566
Cites: World J Surg. 1987 Jun;11(3):319-243604239
Cites: Arch Chir Neerl. 1953;5(4):262-7013140002
Cites: Am J Surg. 1961 Aug;102:136-4213712195
Cites: Br J Surg. 1964 Jul;51:500-314199058
Cites: Can Med Assoc J. 1971 Aug 7;105(3):263-9 passim5563345
PubMed ID
2930287 View in PubMed
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Perforated peptic ulcer over 56 years. Time trends in patients and disease characteristics.

https://arctichealth.org/en/permalink/ahliterature219703
Source
Gut. 1993 Dec;34(12):1666-71
Publication Type
Article
Date
Dec-1993
Author
C. Svanes
H. Salvesen
L. Stangeland
K. Svanes
O. Søreide
Author Affiliation
Department of Surgery, Haukeland University Hospital, University of Bergen, Norway.
Source
Gut. 1993 Dec;34(12):1666-71
Date
Dec-1993
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Circadian Rhythm
Duodenal Ulcer - complications
Female
Humans
Length of Stay
Male
Middle Aged
Norway - epidemiology
Peptic Ulcer Perforation - epidemiology - mortality - surgery
Postoperative Complications
Seasons
Sex Distribution
Stomach Ulcer - complications
Abstract
Perforated gastroduodenal ulcer was studied in 1483 patients in the Bergen area during the years 1935-90 to discover time trends in age and sex, disease characteristics, treatment, and outcome. The male:female ratio fell from 10:1 to 1.5:1, median age increased from 41 to 62 years. Most perforations were found in the duodenum in 1935-64, and in the pyloric and praepyloric area in 1965-90. There was a 10% occurrence of gastric ulcers throughout the study period. Ulcer site was related to age (more gastric and less duodenal perforations with increasing age) and sex (more pyloric and less duodenal ulcers among women). There were twice as many perforations in the evening compared with the early morning. The diurnal variation was more pronounced for duodenal and pyloric than for gastric and praepyloric perforations. Circadian and seasonal variation of ulcer perforation did not change during the 56 years studied. Treatment delay increased from median five hours to median nine hours. Infective complications and mortality fell with the introduction of antibiotics around 1950. General complications has increased in recent years because of the increase of elderly patients. Among patients who died, the proportion with associated disease rose from 27 to 85% during the study period.
Notes
Cites: Br Med J. 1966 Mar 19;1(5489):701-55929935
Cites: J Clin Gastroenterol. 1988 Jun;10(3):259-682980759
Cites: Can Med Assoc J. 1971 Feb 6;104(3):201-55539727
Cites: Gastroenterology. 1972 Jun;62(6):1120-45050311
Cites: Am Surg. 1980 Feb;46(2):61-67369630
Cites: Lancet. 1981 Jun 13;1(8233):1302-46112615
Cites: Ann Surg. 1982 Mar;195(3):265-97059238
Cites: Gastroenterology. 1983 Jun;84(6):1553-76840483
Cites: Gastroenterology. 1983 Jun;84(6):1558-626840485
Cites: Aust N Z J Surg. 1984 Feb;54(1):59-616586169
Cites: Lancet. 1985 Jun 29;1(8444):1504-52861428
Cites: Arch Chir Neerl. 1953;5(4):262-7013140002
Cites: Br Med J. 1955 Jul 23;2(4933):222-714389732
Cites: Acta Chir Scand. 1964 Oct;128:406-1314211294
Cites: Gut. 1964 Dec;5:590-614244037
Cites: Lancet. 1986 Mar 1;1(8479):489-922869219
Cites: Gut. 1986 Oct;27(10):1138-423781325
Cites: Am J Epidemiol. 1988 Oct;128(4):761-703269215
Cites: Br J Surg. 1988 Aug;75(8):758-93167522
Cites: Ann Surg. 1989 Apr;209(4):418-232930287
Cites: Ann Surg. 1989 Jun;209(6):693-6; discussion 696-72730181
Cites: Am Surg. 1990 Apr;56(4):270-41973032
Cites: Surg Gynecol Obstet. 1990 Oct;171(4):315-202218836
Cites: Am J Epidemiol. 1992 Mar 1;135(5):521-301570818
Cites: Aust N Z J Surg. 1969 Feb;38(3):243-525251162
PubMed ID
8282252 View in PubMed
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Prognostic importance of radical lymphadenectomy in curative resections for gastric cancer.

https://arctichealth.org/en/permalink/ahliterature23559
Source
Eur J Surg. 1994 Sep;160(9):497-502
Publication Type
Article
Date
Sep-1994
Author
A. Viste
K. Svanes
C W Janssen
H. Maartmann-Moe
O. Søreide
Author Affiliation
Department of Surgery, University of Bergen, Norway.
Source
Eur J Surg. 1994 Sep;160(9):497-502
Date
Sep-1994
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Gastrectomy - adverse effects - methods - mortality
Humans
Lymph Node Excision - adverse effects - methods - mortality
Male
Middle Aged
Multivariate Analysis
Postoperative Complications - mortality
Prognosis
Regression Analysis
Retrospective Studies
Splenectomy - adverse effects - methods - mortality
Stomach Neoplasms - mortality - pathology - surgery
Survival Rate
Time Factors
Abstract
OBJECTIVE: To evaluate the effect of extensive lymphadenectomy on survival in patients with gastric cancer. DESIGN: Retrospective analysis SETTING: University Hospital, Norway. SUBJECTS: 183 patients with stomach cancer resected for cure during the time period 1980-90. INTERVENTIONS: 78 patients had an R1- and 105 patients and R2 resection. 124 patients were treated by total gastrectomy, 5 by proximal--and 54 by distal resection. MAIN OUTCOME MEASURES: Morbidity, mortality and long term survival. RESULTS: The morbidity was 33% (60/183), of which 39 (21%) were general complications (pneumonia, thrombosis, or cardiovascular disease). 14 patients died postoperatively (8%). By logistic regression analysis we found that splenectomy was the only variable associated with both morbidity and immediate postoperative mortality. Five year survival was 39% for patients who had undergone curative resections, 30% for patients who had had an R1 resection, and 47% for those who had had an R2 resection. By multivariate analysis (Cox) we found that N-classification (TNM), tumour diameter of less than 45 mm, type of lymph node dissection (R2) and operation period (after 1984) correlated with improved survival. CONCLUSION: Extensive lymph node dissection improves survival without increasing morbidity or postoperative mortality.
PubMed ID
7849169 View in PubMed
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Survival after peptic ulcer perforation: a time trend analysis.

https://arctichealth.org/en/permalink/ahliterature210494
Source
J Clin Epidemiol. 1996 Dec;49(12):1363-71
Publication Type
Article
Date
Dec-1996
Author
C. Svanes
R T Lie
S A Lie
G. Kvåle
K. Svanes
O. Søreide
Author Affiliation
Department of Surgery, Haukeland Hospital, Oslo, Norway.
Source
J Clin Epidemiol. 1996 Dec;49(12):1363-71
Date
Dec-1996
Language
English
Publication Type
Article
Keywords
Cohort Effect
Female
Follow-Up Studies
Humans
Male
Norway - epidemiology
Peptic Ulcer Perforation - etiology - mortality - surgery
Regression Analysis
Risk factors
Survival Rate - trends
Time Factors
Abstract
The survival of 1098 patients with ulcer perforation in Norway during the period 1952-1990 was compared with expected survival. Cox regression models incorporating population mortality rates, were used to analyse effects of sex, age, year of birth, and year at risk on excess mortality. Survival was lower in patients than in the general population through a follow-up period of 38 years. Relative survival was lower in women as compared to men, due to more delayed treatment. Long-term survival was lower after praepyloric perforations than after the other perforation types. Relative survival was higher in patients treated 1952-1970 than in those treated more recently. However, adjustment for year of birth revealed a decline in short-term mortality with calendar time, which is in accordance with improved management during the study period. Relative mortality, particularly long-term mortality, was higher in younger birth cohorts, suggesting a shift towards more serious etiologies.
PubMed ID
8970486 View in PubMed
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