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Biomedical subjects

A Thulin

Publications and source records attributed to A Thulin.

At least 19 recordsLinked to original sources
PubMed1995

Clusters of acute appendicitis: further evidence for an infectious aetiology.

BACKGROUND: The aetiology of appendicitis, the commonest cause of acute abdomen, is unknown. Infection has been proposed but the evidence has been unconvincing. The purpose of the present study was to investigate if temporo-spatial clustering and outbreaks, characteristics of infectious diseases, could be found in appendicitis cases in a defined Swedish population. METHODS: Temporo-spatial clustering among 1155 cases from three districts of Jönköping County in 1984-1990 was identified by Knox space-time cluster analysis. Outbreaks were identified by retrospective study of temporal variations in 3590 consecutive cases of acute appendicitis from the city of Jönköping in 1969-1990. RESULTS: Space-time clustering was found among patients with operations less than 60 days apart (observed/expected [O/E]-ratio 1.46, P = 0.016). Subset analysis revealed clustering to be commonest among patients from the same households (O/E-ratio 6.52, P = 0.012), among patients younger than 15 years (O/E-ratio 3.61, P = 0.004) and among females (O/E-ratio 2.28, P = 0.004). Three outbreaks with a significantly increased number of cases were observed during the 22-year study period (O/E-ratio 1.6-2.2, P = 0.001-0.049). CONCLUSIONS: The finding of temporo-spatial interaction and outbreaks among appendicitis cases supports the concept that appendicitis may be caused by infectious agents.

Acute Disease↗
PubMed1994

Indications for operation in suspected appendicitis and incidence of perforation.

OBJECTIVE: To clarify poorly understood epidemiological features of appendicitis. DESIGN: Retrospective study of consecutive cases from a defined population and analysis of data from published studies. SETTING: County of Jönköping, Sweden. 3029 patients who underwent operation in 1984-9 and 4717 patients from the county town who underwent operation in 1970-89, all for suspected appendicitis, plus 48,426 cases from six reported studies. MAIN OUTCOME MEASURES: Incidences specific for age and sex and temporal trends of perforating and non-perforating appendicitis and removal of a normal appendix. Associations between diagnostic accuracy, rate of perforation, and incidences of removal of a normal appendix and of perforating and non-perforating appendicitis. RESULTS: The incidence of appendicitis was 116/100,000 inhabitants. Appendicitis was more common in male patients. The incidence of perforating appendicitis was independent of age, stable over time, and uninfluenced by the rate of laparotomy, whereas the incidence of non-perforating appendicitis was age dependent, decreasing over time, and related to the diagnostic accuracy and rate of removal of a normal appendix. CONCLUSIONS: Perforating and non-perforating appendicitis seem to be separate entities, and appendicitis that resolves spontaneously is common. This may have important implications for managing suspected appendicitis.

Adolescent↗
PubMed1989

Effects of streptozocin-induced diabetes on sympathetic and parasympathetic stimulation of parotid salivary gland function in rats.

Diabetes was induced with streptozocin in male Wistar rats. After 4-6 mo, parotid salivary flow was induced by stimulating bipolar electrodes (3-5 V for 2 ms) on either the auriculotemporal nerve (5 Hz) or the cervical sympathetic trunk (10 Hz). During parasympathetic stimulation, flow rates were 443 +/- 287 microliters/30 min in diabetic animals compared to 657 +/- 134 microliters/30 min in controls (P less than .01). Although parotid flow rates during parasympathetic stimulation were well maintained in controls, they decreased rapidly in most diabetic rats. Parotid secretory response to sympathetic stimulation was also reduced in diabetic compared with control animals (40 +/- 16 microliters/30 min and 82 +/- 50 microliters/30 min, respectively, P less than .01). In contrast to results obtained with direct neural stimulation, no differences in threshold dose or total saliva were observed when cholinergic (methacholine) and peptidergic (physalaemin) agonists were administered intravenously. Response threshold for an adrenergic agonist (epinephrine) was significantly increased in diabetes. Electron microscopy showed axoplasmic abnormalities in nonmyelinated axons in diabetic glands but not in control glands. Although most nerve profiles appeared normal, neuroaxonal abnormalities were found in every diabetic animal. The ultrastructural findings and the similar responses to methacholine and physalaemin suggest that autonomic neuropathy may be a factor in the abnormal response of the parotid gland to parasympathetic nerve stimulation.

Amylases↗
PubMed1989

Evaluation of anamnestic data in patients referred for oral cholecystography.

The knowledge about how patients are selected for elective gallbladder investigations is limited. In this study the anamnestic data of 817 patients referred for an elective cholecystography have been compared with those of 789 matched controls. Other diseases in the medical history were commonly seen, and different gastrointestinal symptoms occurred frequently in the patients. Only 207 (23%) patients presented with a gallstone disease, and no symptom was commoner in these patients than in the patients with normal cholecystograms. The low positive yield could be due to liberal and unclear indications for oral cholecystography. Many gallstones detected this way may in fact be asymptomatic, which should be borne in mind when a cholecystectomy is considered.

Adolescent↗
PubMed1987

Electron microscopy of watery vacuole formation in rat parotid acinar cells during reflex stimulation.

Reflex stimulation from eating hard chow caused variable degrees of watery vacuolation, most conspicuously in animals that had eaten the most food; this was accentuated by eating in the cold. Some vacuolation occurred in the absence of sympathetic impulses but there was much more in glands receiving both parasympathetic and sympathetic impulses. Vacuole formation was often associated with, but not dependent upon, a degree of acinar degranulation. The vacuoles appeared to originate either from the inner side of the Golgi apparatus, near condensing vacuoles, or from ballooning within the rough endoplasmic reticulum; some vacuoles appeared to arise close to secretory granules. Certain cellular components, including secretory granules, entered the contents of vacuoles, which also often had connections with lumina. Many basally-located vacuoles were large and bounded only by a tenuous layer of cytoplasm which was contained by the basal lamina. Vacuole formation may be related to strong stimulation of susceptible cells, which occurs to a variable extent during natural reflex secretion, as well as during artificial stimulation. Thus, under normal conditions, certain macromolecular components might enter saliva via this route and not solely by exocytosis. Leakages from acinar vacuoles could also occur into the glandular interstices, accounting for some of the parotid amylase found in peripheral blood.

Animals↗
PubMed1985

Secretion of parotid acinar granules in rats during reflex stimulation after chronic sympathectomy.

After chronic post-ganglionic sympathectomy the ultrastructure of 'resting' parotid acinar cells in rats remains relatively normal, despite the loss of nerve impulses normally causing secretion of acinar granules from this gland. The question whether eating hard chow still induces some acinar degranulation weeks after superior cervical ganglionectomy, has now been tested. It was found that scattered pockets of parotid acinar degranulation did occur. Some of these changes after unilateral denervation may have been attributable to intact sympathetic nerves arising from the contralateral superior cervical ganglion (Alm, Asking, Emmelin & Gjörstrup, 1984), but this cannot explain similar changes that occurred in glands after bilateral ganglionectomy. The possibility that some degranulation may be induced by circulating catecholamines was tested, 9-16 weeks after unilateral sympathectomy, by placing animals in the cold (0-4 degrees C) for 2 h before removal of tissues. Animals not given food during that time showed no evidence of parotid acinar degranulation, but those given hard chow showed extensive acinar degranulation in both parotid glands. On the sympathectomized side the degranulation was, however, less uniform and more patchy than on the side with an intact innervation. These findings agree with he belief that circulating catecholamines can, at times, induce degranulation of parotid acinar cells made supersensitive by chronic sympathetic denervation but, for it to occur, the cells must also be receiving parasympathetic stimulation at the same time. This interaction probably permits a sufficient turnover of granules to maintain a relative homoeostasis of the parotid acinar cells in rats.

Animals↗
PubMed1985

Endoscopic findings in patients with ulcer-like dyspepsia.

One hundred and sixty-seven patients in a single general practice who presented with ulcer-like dyspepsia were offered an upper gastrointestinal fibre endoscopy. Twenty-two patients had a peptic ulcer while only three had a gastric ulcer. One patient had a carcinoma of the cardia, one an adenocarcinoma in the body of the stomach and one a carcinoma at the ampulla of Vater. In another 55 patients the main findings at endoscopy were edema/reddening or erosions in the antral or duodenal mucosa. Endoscopic findings were normal in 46 patients. Malignancies were found only in patients over 50 years of age and only 4 ulcers were seen in patients under 40. The clinical findings of presence of night pain, pain relief after food intake and history of peptic ulcer were more common in patients with an existing peptic ulcer than in those with a normal endoscopy.

Adolescent↗
PubMed1984

Influence of circulating catecholamines on protein secretion into rat parotid saliva during parasympathetic stimulation.

Secretion of proteins by rat parotid glands in response to parasympathetic nerve stimulation was studied in vivo during pentobarbitone anaesthesia. Parasympathetic stimulation (3-10 Hz) via the auriculotemporal nerve resulted in a copious flow of saliva low in protein. In contrast, sympathetic stimulation (5 Hz) via the cervical sympathetic trunk evoked saliva low in volume but high in protein. Nevertheless, the specific concentrations of amylase and peroxidase (mg/mg protein) and the ratio of amylase to peroxidase remained constant. Sodium dodecyl sulphate (SDS) polyacrylamide gel electrophoresis revealed a single, rapidly migrating protein band of unknown identity in proportionately greater amounts in parasympathetic saliva than in sympathetic saliva. Bilateral adrenalectomy led to reduced amylase and peroxidase secretion in response to parasympathetic stimulation both on a mg/ml and a mg/mg protein basis. SDS gel electrophoresis also demonstrated the decrease in specific amylase concentration following adrenalectomy. The ratio of amylase to peroxidase, however, was not significantly affected. Administration of 6-hydroxydopamine 17-72 h prior to adrenalectomy caused no further reduction in the secretion of amylase and peroxidase. Chronic sympathectomy of 2.5-4 months duration resulted in an increased protein secretion (mg/ml) by the parotid gland in response to parasympathetic stimulation. This increase was only slightly reduced by bilateral adrenalectomy. However, as observed in non-sympathectomized rats, adrenalectomy caused a significant reduction in the specific concentrations of both amylase and peroxidase, but did not affect the amylase to peroxidase ratios. We conclude that parasympathetic nerve stimulation of rat parotid glands after overnight starvation causes secretion of proteins in proportions similar to, but in significantly lower concentrations than those found in sympathetic saliva. Circulating catecholamines, however, influence the amount of amylase and peroxidase secreted by the rat parotid gland in response to parasympathetic nerve stimulation and account for most of the increased secretion of these enzymes following chronic sympathectomy.

Adrenalectomy↗
PubMed1983

Atropine-resistant secretion of parotid saliva on stimulation of the auriculo-temporal nerve.

Non-adrenergic non-cholinergic parasympathetic secretory responses in parotid glands of rats have been demonstrated by electrical stimulation of the auriculo-temporal nerve after appropriate blocking drugs and compared with secretion in the absence of these drugs. After atropine +/- adrenergic blocking drugs secretion was greatly reduced but some secretion was always evident at frequencies of 5 Hz and higher. The time taken for secretion to appear was greatly increased and this may relate to an absence of accompanying myoepithelial contraction. Continuous stimulation always produced greater flows of saliva than intermittent bursts of stimulation at higher frequencies both in the absence and in the presence of blocking drugs. Thus it is likely in vivo that secretion is induced by relatively steady nerve-impulse traffic at moderate frequencies rather than by bursts of high frequency stimulation. Possible transmitters contributing to the atropine-resistant secretion are considered.

Adrenergic alpha-Antagonists↗
PubMed1983

Infectious complications of the abdomen following gastric operations.

A retrospective study of postoperative abdominal infectious complications has been carried out for 625 consecutive patients operated upon for various gastroduodenal disorders during a ten year period; 14.7 per cent of the patients had a wound infection postoperatively and 6.6 per cent, an intra-abdominal abscess. In two-thirds of the patients with an abscess, a leakage was noted from an anastomosis. The patients who seemed to possess a particular risk of having septic complications postoperatively were those operated upon to control bleeding, patients having a second operation during the same hospital stay, patients operated upon for a recurrent ulcer and those operated upon for cancer. Furthermore, the type of operation performed, the age of the patient and some other patient related and hospital related factors, particularly coexisting hypoproteinemia or hypoalbuminemia, or both, seemed to influence adversely the infectious morbidity. The significance of these postoperative complications is also illustrated by the mortality figures and by the increased hospital stay brought about by these complications.

Abdomen↗
PubMed1982

Diagnosis and treatment of gallstone ileus. Report of 83 cases.

83 patients with gallstone ileus treated at 6 hospitals in Sweden during 1960-1979 are presented. Overall mortality was 26.5%. The high age (mean 75 years) and poor general condition of many patients seem to be the main reason for the high mortality rate. 76 patients (92%) were laparotomized and in 63 (76%) the operative procedure was limited to enterolihotomy. Three of these patients had later a second attack of gallstone ileus; other late complications of the gallbladder disease were rare and less serious. In three patients a cholecystectomy was added to enterolithotomy. The postoperative period for these patients was uneventful while postoperative mortality was high (60%) in 5 patients operated with enterolithotomy and small intestinal resection.

Cholelithiasis↗