Biomedical subjects
A Skarstein
Publications and source records attributed to A Skarstein.
[Surgical technical procedures in gastroenterologic and endocrine surgery].
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[Choice of suture material].
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The diagnosis of peritonitis.
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[Physiopathological mechanisms in acute pancreatitis].
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Single dose pre-operative antimicrobial prophylaxis in abdominal operations.
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Changes in gastric mucosal morphology, capillary permeability and blood flow during the first 3 days of acute gastritis in cats.
In the present investigation gastric morphology, blood flow, vascular permeability and water content were studied in cat stomachs with acetic acid-induced gastritis at different time intervals up to 3 days after induction of gastritis. The morphological changes including mucosal erosions, edema and hemorrhage showed normalization within 3 days. The mucosa and muscularis blood flow remained essentially unchanged compared with pre-gastritis values and with the control group. Gastritis was associated with leakage of circulating albumin into the stomach wall most pronounced 4 h after the induction of gastritis. The water content was high at 4 and 24 h after induction of gastritis with almost normalization at 3 days. The morphologaical characteristics of our model are very similar to those observed in man. Leakage of circulating albumin into the gastric wall seems to be the best parameter for quantifaication of the inflammatory changes found in acute gastritis, while blood flow seems to be a less important parameter.
Partial gastrectomy for peptic ulcer by the Krønlein method. Long term results 12 years later with particular reference to general health condition and working capacity.
A one-year material of 97 patients was studied 12 years after partial gastrectomy for peptic ulcer. These patients had all been subjected to a standard Billroth II type operation as described by Krønlein, with emphasis laid upon a transverse position of the gastrojejunostomy. Of the seventy-six patients who were available for evaluation, 15 patients (20%) had some symptoms. The overall grading of results according to Visick was: I in 80 per cent, II in 9 per cent, IIIs in 7 per cent, IIIu + IV in 4 per cent. Three patients had retired and one had changed work partly because of postoperative symptoms.
Partial gastrectomy for peptic ulcer by the Krønlein method. An outpatient follow-up study 12 years later with particular reference to endoscopy with biopsy and brush cytology and to clinical-chemical and radiological results.
Forty-six patients were studied 12 years after partial gastrectomy for peptic ulcer. They had all been subjected to a standard Billroth II type operation as described by Krønlein, with emphasis laid upon the transverse position of the gastrojejunostomy. The clinical examination was supplemented by an outpatient gastroscopy with photography, biopsy and brush cytology, and by a series of blood analyses and X-ray of the gastric remnant. The general finding on gastroscopy was a slightly injected mucosa with flattened folds near the anastomosis, no or slight reflux of bile. The cytological examination revealed metaplasia in 7.5-15 per cent of the specimens, no sign of dysplasia or carcinoma. Biopsy showed severe atrophic gastritis in 0-13 per cent of the specimens, slight to moderate in 58-96 per cent, no signs of cellular atypia or irregular arrangements. Judged by the results of blood analyses a deficiency in iron, Vitamin B12 or both, was demonstrated in about 25 per cent of patients and of these more than 50 per cent were anaemic. X-ray examination showed that 70 per cent of the patients had an emptying time of the gastric remnant of 10-20 minutes. A transverse position of the anastomosis could be demonstrated in about 67 per cent. The necessity of a close follow-up of these patients is stressed.
Effect of partial gastric devascularization on mucosal blood flow and acid secretion in cats.
Partial devascularization of the stomach was performed in cats anesthetized with pentobarbital. The devascularization included all blood vessels along the greater curvature and two of the main branches of the left gastric artery. Gastric mucosal blood flow and cardiac output were determined by means of the microsphere distribution technique. The acid (H+) output from the 30th to the 60th min of pentagastrin stimulation was used as the 'acid response value'. Blood flow and acid secretion were determined before and approximately 2 h after devascularization or sham operation. A marked decrease in acid secretion and mucosal blood flow of the corpus/fundus occurred after devascularization. A high degree of correlation was found between the decrease in acid secretion and the decrease in mucosal blood flow caused by the devascularization. The regression coefficient of acid secretion on mucosal blood flow did not change significantly after devascularization.
Blood flow distribution in the stomach of cats with acute gastric ulcer.
An ulcer was induced in the anterior wall of the antrum of cats by local injection of acetic acid solution. Carbonized microspheres, 15 +/- 5 microns in diameter, labelled with 141Ce, were used to measure blood flow in different regions and layers of the stomach wall. The radioactivity of a blod reference sample and of tissue samples was determined, and the blood flow was calculated for each tissue sample. The gastric tissue samples were examined microscopically, and the level of gastrin in serum was determined. Two groups of anaesthetized animals were used: in one group of animals blood flow was determined 24 h after ulcer induction and in a group of control animals 24 h after laparotomy. In the ulcer animals the gastric blood flow as increased both in the mucosa and in the muscularis in a zone around the ulcer. Microscopic examination revealed tissue necrosis corresponding to the floor of the ulcer and acute inflammatory changes in the gastric wall around the necrotic area. The serum gastrin concentration tended to increase after ulcer induction.
Effect of indomethacin on blood flow distribution in the stomach of cats with acute gastric ulcer.
An ulcer was induced in the anterior wall of the antrum of cats by local injection of acetic acid solution. Carbonized microspheres, 15 +/- microns in diameter, labelled with 141Ce, 46Sc, and 85Sr, were used to measure blood flow in different regions and layers of the stomach wall. The radioactivity of a blood reference sample and of tissue samples was determined, and the blood flow was calculated for each tissue sample. The blood flow distribution was determined before, 1/2 h, and 1 h after an intravenous infusion of indomethacin in a dose of 3 mg/kg. Two groups of anaesthetized animals were used: animals with a 24-h gastric ulcer and control animals 24 h after laparotomy. In the control animals indomethacin caused a mean reduction in gastric mucosal blood flow of approximately 50%. The flow reduction was about the same in different regions of the stomach. In the muscularis there was no change in blood flow after indomethacin. The blood flow was reduced in the duodenum and jejunum but not in the other intestinal organs studied. The blood pressure and cardiac output remained unchanged. In the ulcer group indomethacin caused about the same reduction in mucosal blood flow. However, the blood flow was reduced less in the ulcer region and tended to increase in the mucosa around the ulcer 1 h after indomethacin infusion.
Distribution of microspheres with different diameters in the small bowel wall of the cat.
The purpose of the present study was to investigate the distribution in the small bowel wall of intracardially injected microspheres with different diameters, and to find a sphere size that could be used for determination of blood flow to the different layers of the bowel wall. Microspheres were injected into the left ventricle of the hearts of cats in the following order of succession, 8--10, 15 +/- 5, 25 +/- 5 and 50 +/- 5 micrometer. Samples of the proximal part of the jejunum and the distal part of the ileum were examined microscopically, and the size and the location of the spheres recorded. The following distribution of the microspheres was found: villi 6--16 micrometer, crypt layer 6--20 micrometer, propria below the crypts and the muscularis mucosa 11--24 micrometer, submucosa 9--66 micrometer and muscularis 6--30 micrometer. Spheres between 8 and 13 micrometer appeared to be fairly uniformly distributed in the different layers of the intestinal wall.
Effect of vasopressin on blood flow distribution in the stomach of cats with gastric ulcer.
An ulcer was induced in the anterior wall of the antrum by local injection of acetic acid solution. Carbonized microspheres 15 +/- 5 micrometer in diameter, labeled with 85Sr and 141Ce, were used to measure blood flow in different regions and layers of the stomach wall, and in each sample the mucosa was separated from the muscularis. The radioactivity of a blood reference sample and the tissue sample was determined, and the blood flow was calculated for each tissue sample. Two groups of anesthetized animals were used: animals with normal stomachs given vasopressin and animals with a 1-week ulcer given vasopressin. The vasopressin was administered intravenously over a 20-min period. In animals with normal stomachs and in animals with a gastric ulcer vasopressin was found to decrease the blood flow to the stomach in all areas examined. The presence of a 1-week ulcer in the cat did not seem to influence the effect of vasopressin.
Effect of partial devascularization on the blood flow distribution in the cat stomach.
Partial devascularization of the stomach was performed in cats anesthetized with pentobarbital. Gastric blood flow distribution and cardiac output were determined by means of the microsphere distribution technique. Blood flow was determined before and 30 min after the partial devascularization. Devascularization of the lesser curvature caused a significant decrease in the mucosal and muscularis blood flow at the lesser curvature. After devascularization of the greater curvature, localized reduction in mucosal and muscularis blood flow occurred at the greater curvature. In the sham-operated animals the muscularis blood flow was significantly higher than in the nonoperated animals.
Distribution of microspheres with different diameters in the stomach wall of cats.
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Effect of pentagastrin on blood flow distribution in the stomach of cats with gastric ulcer.
Ulcer was induced in the anterior wall of the antrum by injection of acetic acid solution. Carbonized microspheres 15 +/- 5 mj in diameter and labelled with 85Sr and 141Ce were used to measure blood flow in different regions and layers of the stomach. The radioactivity of the blood and tissue samples was determined, and the blood flow was calculated for each tissue sample. Three groups of anaesthetized animals were used: 1) animals, with normal stomachs, 2) animals with normal stomachs given pentagastrin, 3)animals with a one-week ulcer given pentagastrin. In animals with normal stomachs given pentagastrin during 20 minutes, the mucosal blood flow increased in all areas of the stomach apart from the antrum. In animals with a gastric ulcer pentagastrin was not found to influence the mucosal blood flow significantly. Pentagastrin was not found to change the muscularis flow in animals with normal stomachs, or in animals with a gastric ulcer.
Perforated peptic ulcer: a comparison of long term results following partial gastric resection or simple closure.
The results of simple closure were compared with those of partial resection in the treatment of perforated peptic ulcer. The investigation was carried out 7-13 years after the primary operation on 126 patients who had been allotted to one of the two treatment methods on the basis of an almost randomized schedule. Better late results were obtained with partial resection than with simple closure in patients in the age range 50-59 years at operation, with short duration of perforation and with a long history of symptoms before perforation. None of the patients treated with partial resection later underwent surgical treatment for recurrence of symptoms. In the simple closure group 27.3 per cent needed further surgery at 3 months to 10 years after perforation.