Perioperative regimens for patients undergoing elective hip or knee arthroplasties.

Background: Elective knee and hip arthroplasty are common surgical procedures. Improved anaesthetic and nutritional care has the potential of increasing patient satisfaction and reducing length of hospital stay (LOS). The overall aim of this thesis was to evaluate the effect of perioperative nutrition and different anaesthetic techniques on per- and postoperative outcome after elective total hip (THA) or total knee arthroplasties (TKA). Methods: In this thesis prospective, randomized trials were performed in 358 patients. Results: Patients undergoing THA received an oral carbohydrate or placebo drink in a randomized controlled trial 90 min before and 120 min after surgery. The treatment resulted in less hunger and nausea and reduced pain compared with placebo. When intrathecal anaesthesia (ITA) and traditional intra- and postoperative care was compared with general anaesthesia (GA) combined with accelerated postoperative care for TKA the LOS was reduced without adversely affecting pain or total satisfaction. TKA patients given identical perioperative treatment were randomized to either ITA or GA and GA resulted in shorter LOS, less nausea, vomiting and dizziness. GA patients also required less postoperative analgesics and had lower pain scores. Patients receiving ITA indicated that they would like to change their method of anaesthesia in the event of a subsequent operation. THA patients receiving either ITA or GA resulted in similar findings as in the TKA-study In conclusion, this thesis shows that perioperative carbohydrate administration has a limited beneficial effect on THA patients. Accelerated postoperative care and GA has favourable recovery effects when compared with ITA and traditional postoperative care. When GA was compared with ITA in a Fast-Track set-up, GA resulted in a more favourable recovery profile for patients undergoing THA or TKA. Both TKA and THA patients preferred GA in case of a future operation

Kvinner i fagbevegelsen : etterslep og nyskapere?

Hovedfagsoppgave i samfunnsvitenskap, våren 198

Negative Pressure Wound Therapy (NPWT) in Breast Surgery

Background: The use of Negative Pressure Wound Dressing has been found to promote the wound healing process, therefore, reducing the risk of surgical site complications. The use of this technique amongst breast cancer patients, who have often encountered a distressing journey, may prove beneficial in making the post-operative process less eventful. Many of these patients have a limited time window to start adjuvant treatment. The use of a negative pressure device is recommended in both prophylactic and therapeutic scenarios. NPWT may also be used in patients who have undergone cosmetic breast surgery. We have evaluated the use of NPWT in breast surgery with an updated and systematic review of the available literature. Methods: The authors systematically searched the PubMed, Science Direct, and Wiley Online databases using the phrases “Negative Pressure Wound Therapy in Breast surgery” and “Vacuum-Assisted Closure in Breast Wound” and all publications, including relevant data were considered eligible for inclusion in the review. Results: We have found reports of 7 studies, 3 retrospective, 2 prospective, one randomized trial, and one case series. The complication rate in the NPWT group versus conventional dressing group has been reported in 5 papers. A statistically significant effect in favor of NPWT was documented in three trials. Conclusion: The current evidence supports the notion that NPWT systems are beneficial in enhancing the healing of complicated breast wounds. However, larger studies exploring the effectiveness of this technique would be of interest to breast surgeons

Posterior Mediastinal Paravertebral Müllerian cyst (cyst of Hattori): literature review

Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal Müllerian cysts of undetermined pathogenesis are very rare occurrences. The first case of a ciliated cyst arising in the mediastinum, of probable Müllerian origin, was reported by Hattori in 2005, which gave rise to the name cyst of Hatorri (COH) The number of reported cases in literature of a similar nature have since then increased significantly.  One of the main concerns about this pathology is the possibility of malignant transformation of the Müllerian tissue. Over the course of this paper we will discuss the pathogenesis, immunohistochemistry and its role in differential diagnosis as well as optimal treatment of such cysts

Higher risk for acute childhood lymphoblastic leukaemia in Swedish population centres 1973-94

A population-based sample of acute childhood leukaemia cases in Sweden 1973–94 was analysed by a geographical information system (GIS) for spatial leukaemia distribution in relation to population density. The annual incidence rate for acute lymphoblastic leukaemia (ALL) was 3.6, and for acute non-lymphoblastic leukaemia (ANLL) 0.7, cases per 100 000 children. Incidence rates in population centres, constituting 1.3% of Sweden's land area and approximately 80% of the population, compared with the rest of Sweden showed a statistically significant excess of ALL [odds ratio (OR) 1.68; 95% confidence interval (CI) 1.44–1.95], but not ANLL (OR 1.13; 95% CI 0.98–1.32). An increasing trend, however not statistically significant, was found for ALL incidence with both increasing population density in parishes and increasing degree of urbanity in municipalities. These findings support the theories that some environmental factors associated with high population density, such as infectious agents, may be of aetiological importance for childhood acute lymphoblastic leukaemia. © 1999 Cancer Research Campaig

Higher occurrence of nausea and vomiting after total hip arthroplasty using general versus spinal anesthesia: an observational study.

BACKGROUND: Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip arthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA) anesthesia has higher causal effect on this occurrence. Conflicting results have been reported. METHODS: In this observational study, we selected all elective THA interventions performed in adults between 1999 and 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on the occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the design and results of an RCT. RESULTS: Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and 1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated, i.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to individuals who received GA, was ATET = 2.00 % [95 % CI, 0.78-3.19 %], which translated into an OR = 1.97 [95 % CI 1.35; 2.87]. CONCLUSION: This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being more strongly associated with PONV than spinal anesthesia in orthopedic surgery

Hyperresponsiveness to inhaled but not intravenous methacholine during acute respiratory syncytial virus infection in mice

BACKGROUND: To characterise the acute physiological and inflammatory changes induced by low-dose RSV infection in mice. METHODS: BALB/c mice were infected as adults (8 wk) or weanlings (3 wk) with 1 × 10(5 )pfu of RSV A2 or vehicle (intranasal, 30 μl). Inflammation, cytokines and inflammatory markers in bronchoalveolar lavage fluid (BALF) and airway and tissue responses to inhaled methacholine (MCh; 0.001 – 30 mg/ml) were measured 5, 7, 10 and 21 days post infection. Responsiveness to iv MCh (6 – 96 μg/min/kg) in vivo and to electrical field stimulation (EFS) and MCh in vitro were measured at 7 d. Epithelial permeability was measured by Evans Blue dye leakage into BALF at 7 d. Respiratory mechanics were measured using low frequency forced oscillation in tracheostomised and ventilated (450 bpm, flexiVent) mice. Low frequency impedance spectra were calculated (0.5 – 20 Hz) and a model, consisting of an airway compartment [airway resistance (Raw) and inertance (Iaw)] and a constant-phase tissue compartment [coefficients of tissue damping (G) and elastance (H)] was fitted to the data. RESULTS: Inflammation in adult mouse BALF peaked at 7 d (RSV 15.6 (4.7 SE) vs. control 3.7 (0.7) × 10(4 )cells/ml; p < 0.001), resolving by 21 d, with no increase in weanlings at any timepoint. RSV-infected mice were hyperresponsive to aerosolised MCh at 5 and 7 d (PC(200 )Raw adults: RSV 0.02 (0.005) vs. control 1.1 (0.41) mg/ml; p = 0.003) (PC(200 )Raw weanlings: RSV 0.19 (0.12) vs. control 10.2 (6.0) mg/ml MCh; p = 0.001). Increased responsiveness to aerosolised MCh was matched by elevated levels of cysLT at 5 d and elevated VEGF and PGE(2 )at 7 d in BALF from both adult and weanling mice. Responsiveness was not increased in response to iv MCh in vivo or EFS or MCh challenge in vitro. Increased epithelial permeability was not detected at 7 d. CONCLUSION: Infection with 1 × 10(5 )pfu RSV induced extreme hyperresponsiveness to aerosolised MCh during the acute phase of infection in adult and weanling mice. The route-specificity of hyperresponsiveness suggests that epithelial mechanisms were important in determining the physiological effects. Inflammatory changes were dissociated from physiological changes, particularly in weanling mice