Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951-1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8.6 per cent mortality in the first 10 years of the period.
The frequency of abdominal injury is rising. In an analysis of 1,354 cases of closed abdominal trauma sustained during a 30-year period (1950-1979) in Skaraborg County, Sweden, a distinct increase was found in the numbers associated with sporting activities. The severity of the injuries caused by sports likewise showed an increase. The representation of injured organs was of the same order as in the total series of closed abdominal injuries. An analysis of the 136 cases of sports-associated injury is presented with regard to cause and type of the injuries, diagnosis and prognosis.
Studies have been made in 1407 patients of the causes, the organs involved and the outcome of injury to the abdomen in patients needing admission to hospital in an area of Southern Sweden, between 1950 and the end of 1979. The proportion of female patients and those aged over 60 increased significantly. The seasonal distribution of the injuries showed significant change, with a drop in the initially high frequency sustained during the summer months. Penetrating injuries were rare, but increased in the 1970s. Road traffic accidents as the cause of abdominal injuries rose to a maximum of 56 per cent in the late 1960s. The numbers of injured organs and the frequency of other associated injuries rose gradually until the mid-1970s, after which there was a slight decrease. The spleen, liver and large blood vessels were the organs which were increasingly often injured. The annual incidence of various visceral injuries per 100 000 population was calculated. The number of patients with a delay of at least 24 hours before operation fell significantly and there was a tendency to shorter hospital stay. The mortality curve showed a peak in the late 1960s.
Abdominal trauma occurring in persons older than 60 years over a 30-year period (1950-79) in a well defined region of Sweden was reviewed. The 177 patients comprised 12.5% of the total with abdominal trauma during that period. Road traffic accidents were the main cause of trauma (48% of cases). The incidence of motor-car accidents rose sharply during the first two decades of the study. Injuries to the liver and bile ducts and multiple intra-abdominal injuries were more common in the elderly than in younger patients, but injury to the abdominal wall was less common. A tendency towards more severe injuries and multiple trauma with extra-abdominal involvement emerged during the study period. The mortality rate was 27.6% in the patients older than 60, but 9.1% in the overall patient series with abdominal trauma. One-third of all the deaths among the older patients were directly due to the abdominal trauma. One consequence of the increasing numbers of old people in the general population is probably that more and more cases of abdominal trauma will be seen in the higher age groups.
Case records of 417 patients, from a well-defined area, who were hospitalized because of blunt renal trauma during the period 1950-1979 were analyzed. The incidence increased during the final decade, corresponding to a rising incidence of motor traffic accidents and sports injuries. Young patients, between 10 and 29 years of age, were responsible for the increase and half of all patients were in this age group. Associated injuries were frequent. Emergency urography was rare during the earlier part of the investigation period, but the frequency increased strongly thereafter. Treatment was mainly conservative (nonoperative) except in patients with major renal injuries. Nephrectomy was performed in 22 patients. Reconstructive surgery was performed especially in patients with intermediate renal injuries during the final decade. The total mortality was 6.5%. Only 7 patients (1.7%) died from the renal injury. A dramatic reduction in the hospitalization time was noted.
In a rural area with a relatively stable population, 216 persons were hospitalized for blunt renal trauma over a 30-year period (1946-75). In the final 10 years the frequency of such trauma increased, as also did the proportions of females and younger patients (11-30 years old). In the final 5 years the overall incidence was 6.2 cases per 100 000 inhabitants and year. Motor traffic accidents were increasingly the cause of blunt renal trauma. Injuries from compression showed a stable frequency. Renal trauma attributed to blows varied with the incidence of accidents involving horses and sports. Treatment was mainly conservative, except in major injuries. Emergency excretory urography was rarely used during the first 10 years of the study, but thereafter with increasing frequency. Early complications were seen only during the first 20 years of the study.
PURPOSE: We studied the depth of invasion in the lamina propria in all patients with primary stage T1 bladder cancer in a geographical region and related the findings to the long-term prognosis. MATERIALS AND METHODS: All 121 primary stage T1 tumors diagnosed in western Sweden between 1987 and 1988 were analyzed with respect to the depth of invasion in relation to the lamina muscularis mucosae. All clinical records were reviewed in 1994 and 1995. RESULTS: More than 90% of the histopathological specimens could be separated into superficially (pT1a) or deeply (pT1b) invasive stage T1 tumors. Grade 3 tumors were significantly more common among patients with stage pT1b disease (79 versus 40%, p 0.05) and an almost doubled risk of dying of bladder carcinoma compared to those with stage pT1a grade 3 disease (45 versus 23%, p > 0.05). Carcinoma in situ at the primary operation was associated with an impaired prognosis in patients with grade 3 tumors regardless of the depth of invasion in the lamina propria. CONCLUSIONS: The prognosis is poor in patients with deep lamina propria invasion (stage pT1b) treated with transurethral resection alone. Patients treated with radical cystectomy had excellent survival regardless of the depth of invasion in the lamina propria. Radiotherapy was associated with poor survival.
Intestinal injuries sustained by 101 Swedish patients during the period 1950-1979 are reviewed. The abdominal trauma was blunt in 78 cases and penetrating in 23. Small-bowel and mesenteric, but not large-bowel, injuries showed increasing frequency. This was associated with rising numbers of motorcar accidents. Injuries to other abdominal organs were found in 56 of the 101 patients, particularly in those with mesenteric or large-bowel trauma. Clear physical signs of intra-abdominal injury led to rapid surgical exploration in most cases, but some operations were performed after relatively long observation. Most injuries, including those in the colon, were treated with primary repair or resection. Decompressive colostomy or exteriorization were rarely performed. Deaths were mainly caused by other factors than the type of operation. The mortality rate (35%) was constant.