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Biomedical subjects

Ake Andrén-Sandberg

Publications and source records attributed to Ake Andrén-Sandberg.

At least 19 recordsLinked to original sources
PubMed2007

Punctate midline myelotomy: a minimally invasive procedure for the treatment of pain in inextirpable abdominal and pelvic cancer.

The midline of the dorsal column contains a pathway that may be more important for transmitting visceral nociceptive signals than the spinothalamic tract. Punctate midline myelotomy, a neuroablative operation with the intent of interrupting the midline of the dorsal column, has demonstrated efficacy in the treatment of otherwise intractable abdominal and pelvic cancer pain. The indications, technical procedure, outcomes, and complications of all published clinical studies of punctate midline myelotomy are reviewed. The lesion level of the spinal cord and the depth of the incision are discussed, with the focus on the feasibility of this technique.

Abdominal Neoplasms↗
PubMed2003

Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment.

INTRODUCTION: Massive bleeding may complicate the course of either acute or chronic pancreatitis. Although the latter is more frequently involved when bleeding occurs in the acute form, a poorer prognosis is to be expected. Abscess, severe inflammation, regional necrosis, and pseudocysts may cause major vessel erosion, with or without pseudoaneurysm formation, whose eventual rupture may result in massive bleeding into the gastrointestinal tract, retroperitoneum, and peritoneal cavity. AIMS: To define the most important pathophysiologic mechanisms and factors that might contribute to a better understanding, better prevention, and more efficient treatment of severe hemorrhage complicating acute necrotizing pancreatitis. Awareness of high-risk conditions occurring during the natural evolution of the disease (from extensive local severe enzymatic damage to late septic sequelae), avoidance of a too early and too aggressive approach to sterile pancreatic necrosis, and providing prompt and effective treatment of local septic complications, when they occur, are crucial steps for bleeding prevention. METHODOLOGY: Forty-four cases of severe bleeding following acute pancreatitis that were reported during the last decade since 1992 (including the six cases reported here) are reviewed, analyzed, and summarized. RESULTS: The overall mortality rate was 34.1%. Splenic artery, portal vein, spleen, and unspecified peripancreatic vessels were the most commonly involved sources of bleeding, with associated mortality rates of 33.3%, 50.0%, 30%, and 28.5%, respectively. Massive hemorrhage was more frequently associated with severe necrosis, with a mortality rate of 37.9%. CONCLUSION: The increased use of diagnostic and interventional radiology, in association with prompt surgical treatment, appears to be the way to improve survival rates in cases of arterial bleeding. Venous bleeding due to lesion of major peripancreatic veins or diffuse bleeding represents a therapeutic challenge, and treatment of these conditions should be tailored to the individual case, as no general rule can be suggested. In extreme cases, open packing or salvage emergency pancreatectomy may represent the only chances for survival.

Adult↗
PubMed2003

Fatal acute pancreatitis. Characteristics of patients never reaching hospital.

BACKGROUND: Mortality in acute pancreatitis is still substantial. The extent of patients dying at home due to acute pancreatitis, thus never admitted to hospital, is scarcely known. MATERIAL AND METHODS: Thirty-six patients with death caused by acute pancreatitis were identified at the Department of Forensic Medicine over a 7-year period. RESULTS: Twenty-seven patients (75%) were assumed to have alcohol as the underlying etiological factor. The duration of abdominal pain seemed short, with a median of one day. Profound pancreatitis changes were found in all patients while pulmonary changes were less frequent. CONCLUSION: Overall, up to 1/3 of patients dying from acute pancreatitis in our region seem to die at home never being admitted to hospital. The majority of instances was caused by alcohol abuse. The progression of the cause of the disease seemed rapid, implying that these patients could constitute a specific subgroup of severe acute pancreatitis.

Acute Disease↗
PubMed2003

Surgical treatment of pancreatic pseudocysts in the 2000's--laparoscopic approach.

A pseudocyst presents as a cystic cavity bound to the pancreas by inflammatory tissue. Typically the wall of a pancreatic pseudocyst lacks an epithelial lining, and the cyst contains pancreatic juice or amylase-rich fluid. Today the mostly used definitions make a difference between peripancreatic fluid collections, pseudocysts after acute and chronic pancreatitis and pancreatic abscess as in the Atlanta classification system for acute pancreatitis. Distinction between pseudocyst and acute fluid collection leads to a better understanding of the natural history of peripancreatic fluid collections and facilitates the progress of the treatment of these two separate entities even though they are a part of a continuous pathological process. The presence of a well-defined wall composed of granulation or fibrous tissue is what distinguishes a pseudocyst from an acute fluid collection. A pseudocyst is usually rich in pancreatic enzymes and is most often sterile. Formation of a pseudocyst requires usually 4 or more weeks (many clinicians state six) from the onset of acute pancreatitis. The differentiation in the Atlanta classification between acute and chronic pseudocyst is important, but it invite to confusion. It is important to note that in the classification the terms "acute" and "chronic" refers to the pancreatitis behind the pseudocyst and not to the mode of symptomatology of the pseudocyst itself. This means that an acute pseudocyst may have be known for months, whereas a chronic pseudocyst in the next patient has been documented only a week or two.

Humans↗