Personality profile in type I alcoholism: long duration of alcohol intake and low serotonergic activity are predictive factors of anxiety proneness.

The aim of the present study was to further investigate personality profiles in male type I alcohol-dependent subjects (n = 33), in relation to central serotonergic neurotransmission, history of excessive alcohol consumption and present use of tobacco. Central serotonergic neurotransmission was assessed by the prolactin (PRL) response to D-fenfluramine. By using the Temperament and Character Inventory and the Karolinska Scales of Personality, all subjects self-rated their personality profile. The results showed that individuals with low PRL response and long duration of excessive alcohol consumption had significantly higher anxiety proneness, and that years of excessive alcohol consumption was the strongest predictor. Long duration of excessive alcohol consumption thus appears to have an influence on personality traits in male type I alcohol-dependent individuals and these personality traits may therefore be a consequence of, rather than preceding, alcoholism in these individuals.

Laparoscopic common bile duct exploration.

OBJECTIVE: To explore the feasibility of laparoscopic techniques for the removal of common bile duct (CBD) stones. DESIGN: Retrospective analysis. SETTING: University hospital, Sweden. SUBJECTS: 39 patients who underwent laparoscopic common bile duct exploration, either by a transcystic technique or by choledochotomy, between September 1992 and April 1995. INTERVENTIONS: Cholecystectomy, intraoperative cholangiography, and removal of CBD-stones by a transcystic technique (n=22), laparoscopic choledocholithotomy (n=11), or after conversion to open choledocholithotomy (n=6). MAIN OUTCOME MEASURES: Stone clearance rates, operative time, complications, and postoperative hospital stay. RESULTS: Stone removal was achieved in 32/39 patients (82%) by a laparoscopic approach. Reasons for failure were early in our experience, and the result of technical difficulties or stones that were too large for the transcystic approach, or with impacted stones at choledochotomy. Postoperative morbidity was low (n=4, 10%) with no mortality. CONCLUSIONS: Common bile duct stones can be removed in a large proportion of patients undergoing laparoscopic cholecystectomy, either by a laparoscopic transcystic technique or through a laparoscopic choledochotomy. The laparoscopic techniques need further evaluation, preferably in prospective multicentre trials comparing other treatment strategies including endoscopic sphincterotomy.

A survey of surgical treatment of gallstone disease and the diffusion of laparoscopic surgery in Sweden 1992-93.

OBJECTIVE: To study the diffusion of laparoscopic biliary surgery in Sweden, 1992-93. DESIGN: A prospective survey of all biliary surgery for gallstone disease recorded for 8 weeks in 1992 and the same period in 1993. SETTING: All surgical departments in Sweden. SUBJECTS: A consecutive series of 1938 patients in 1992 and 1748 patients in 1993. MAIN OUTCOME MEASURES: The changing indications, diffusion, morbidity, mortality, postoperative and hospital stay after laparoscopic cholecystectomy (LC) in Sweden in 1992 compared with 1993. RESULTS: Despite the spread of LC, the indications did not change between 1992 and 1993 (p=0.31). The total number of cholecystectomies decreased from 1938 in 1992 to 1748 in 1993. The overall percentage of laparoscopic cholecystectomies (LCs) increased from 74.7% to 81.2% (p <0.001) between 1992 and 1993. Postoperative morbidity and mortality after LC did not differ between 1992 and 1993, but the total morbidity was 9.0% in 1992 and 7.0% in 1993 (p=0.02). Mortality for all cholecystectomies did not change over the periods, being 0.6% in 1992 and 0.2% in 1993 (p=0.07). The numbers of LCs done in any hospital were divided in two groups, 20 or fewer and 21-80. In the smaller group, the postoperative morbidity was 7.1% and in the larger group it was 7.0%, (p=0.9). The postoperative mortality was 0.1% in both groups. The postoperative and total hospital stays of all cholecystectomies decreased from 3.4 days in 1992 to 2.9 days in 1993 (p=0.001) and from 5.0 in 1992 to 4.4 days in 1993 (p < 0.001), respectively. The postoperative and total hospital stays of LCs decreased from 2.0 in 1992 to 1.8 days in 1993 (p=0.009) and from 3.3 in 1992 to 2.9 days in 1993 (p=0.007), respectively. CONCLUSION: Despite the introduction and diffusion of the new technology, LC, the indications for surgery did not change and the number of cholecystectomies did not increase from 1992 to 1993. The morbidity and mortality of LC and the mortality of all cholecystectomies were unchanged between 1992 and 1993, but the morbidity for all cholecystectomies decreased. The number of LC or all cholecystectomies done in any particular hospital were not related to morbidity or to mortality.

Reported burning mouth symptoms among middle-aged and elderly women.

The aims of this investigation were to assess the prevalence of burning mouth symptoms (BM) in a representative population of Swedish middle-aged and elderly women (n=1017) and its relation to general and oral health status. BM was reported by 4.6% (n=47), and 85% of the BM subjects had experienced BM for more than 6 months. A stepwise multiple logistic regression with BM/non-BM as dependent variable showed that 7 covariates were found to be predictive of BM. These variables were medication with antihypertensives, sedatives and female sex hormones. Moreover, headache, tinnitus, dry mouth, and reduced chewing ability were included in the final model.

A cost-minimization analysis of laparoscopic cholecystectomy versus open cholecystectomy.

BACKGROUND: Earlier economic analyses have evaluated charges but not costs, and have not considered the cost of production losses associated with open and laparoscopic cholecystectomy. This study attempted to accomplish an economic evaluation of open versus laparoscopic cholecystectomy from the point of view of society. METHODS: A cost-minimization analysis, using a clinical decision model, was performed. The data used were taken from different clinical studies, Swedish national registers, local patient statistics, and hospital accounting systems. The direct and indirect costs were measured. RESULTS: Laparoscopic cholecystectomy resulted in cost savings per patient amounting to about 2,400 SEK (as of 31 August 1994, Pound = 11.90 SEK; $1 = 7.76 SEK) compared with open surgery. CONCLUSIONS: From the point of view of society, laparoscopic cholecystectomy was a cost-saving strategy if at least 68 patients were operated on yearly. However, with regard to hospital costs, open cholecystectomy was less expensive than laparoscopic cholecystectomy.

Effects of pneumoperitoneum on splanchnic hemodynamics: an experimental study in pigs.

OBJECTIVE: To study the effects on splanchnic haemodynamics of pneumoperitoneum induced by carbon dioxide insufflation. DESIGN: Controlled experimental study. ANIMALS: 11 Pigs weighing 19-30 kg. INTERVENTION: The animals were divided into a control group (n = 4) and a experimental group (n = 7). Experimental animals were subjected to stepwise increasing intra-abdominal pressure from 0 mm Hg to 25 mm Hg by carbon dioxide insufflation. MAIN OUTCOME MEASURES: Portal venous blood flow, portal venous blood pressure, portal/hepatic vascular resistance, and gastrointestinal vascular resistance. RESULTS: At 25 mm Hg portal venous blood flow was reduced (66% of baseline), and portal venous blood pressure and portal/hepatic vascular resistance were increased (360% and 650% of baseline, respectively). The increase in gastrointestinal vascular resistance was less pronounced. CONCLUSIONS: Increased intra-abdominal pressure caused significant changes in the splanchnic haemodynamics. The risk was greater if the intra-abdominal pressure exceeded 15 mm Hg.

Cerebrospinal fluid levels of monoamine metabolites. A preliminary study of their relation to menstrual cycle phase, sex steroids, and pituitary hormones in healthy women and in women with premenstrual syndrome.

The cerebrospinal fluid (CSF) levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), the noradrenaline metabolite 3-methoxy-4-hydroxyphenylethylene glycol (MHPG), and the dopamine metabolite homovanillic acid (HVA) were measured in a group of drug-free non-depressed women with premenstrual syndrome (PMS) (late luteal phase dysphoric disorder) (n = 13) and in controls with no premenstrual complaints (n = 13). In six patients and eight controls, CSF samples from both the luteal and the follicular phase were obtained, whereas in the remainder of the subjects, samples from either the follicular phase (patients: 4, controls: 2) or the luteal phase (patients: 3, controls: 3) were taken. The following observations were made: (1) Neither in the follicular phase nor in the luteal phase did the mean concentrations of CSF monoamine metabolites in the PMS group differ from the corresponding values in the control group. (2) Neither in the PMS group nor in the control group did the mean concentrations of monoamine metabolites in CSF samples obtained in the luteal phase differ from the corresponding values obtained in the follicular phase. (3) The intraindividual, intersample variations of CSF HVA and 5-HIAA concentrations were significantly smaller in the PMS group than in the control group. (4) CSF HVA correlated strongly to CSF 5-HIAA in the luteal phase of both patients and controls whereas in the follicular phase, particularly in controls, this correlation was much weaker. (5) In the luteal phase, the CSF HVA/5-HIAA ratio correlated negatively to serum levels of estradiol, progesterone, and testosterone. (6) The CSF HVA/5-HIAA ratio was significantly lower in PMS patients than in controls. (7) A positive correlation between CSF MHPG and serum luteinizing hormone was observed in the follicular phase. (8) A positive correlation between CSF HVA and serum prolactin was observed in the luteal phase. Because the study was comprised of a small number of subjects, the reported findings until replicated should be interpreted with caution.

Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses.

Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis. There is very little evidence, however, to support the claimed benefit to patients. In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were randomized to laparoscopic or conventional open cholecystectomy. Median (interquartile range) intravenous consumption of pethidine with a patient-controlled injection device between 13 and 24 h after surgery was 125 (62-175) mg in patients who underwent the laparoscopic procedure and 200 (150-250) mg in those who had open operation. Urinary adrenaline and cortisol levels as well as those of plasma glucose, C-reactive protein and interleukin 6 were increased after surgery in both groups of patients, but without any significant difference between them. The mean(s.d.) duration of postoperative hospital stay (2.8(0.8) versus 1.8(0.6) days) and sick leave (24.0(4.4) versus 11.7(4.1) days) was significantly longer with open than laparoscopic cholecystectomy. The findings demonstrate obvious advantages of laparoscopic surgery as regards postoperative pain and convalescence, although factors reflecting the magnitude of trauma did not differ.

Eleven years of aortic aneurysm surgery: changes in techniques and results.

This study presents data from aortic aneurysm surgery during the two periods 1974-1981 and 1982-1984. During the last period most elective patients were operated on under epidural analgesia. The proportion of electively operated patients increased from 44% to 65%. The blood loss decreased significantly from the early to the late period. The mortality rate decreased from 58% to 43% for acute, and from 12% to 6% for elective patients.