Biomedical subjects

D Holmlund

Publications and source records attributed to D Holmlund.

At least 19 recordsLinked to original sources

PubMed1987

Long-term effects of surgery for normocalcaemic hyperparathyroidism.

A retrospective study of the long-term effects of surgery for normocalcaemic hyperparathyroidism in 82 patients is presented. The median postoperative follow-up time was 96 months. In most of the patients recurrent renal calculi had been the main preoperative symptom, and intermittent peaks of hypercalcaemia were recognized in more than 50% of them. Of the 19 patients with severe tendency to calculus formation, 12 appeared to have been cured by parathyroidectomy. These cured patients were found at operation to have parathyroid adenoma or hyperplasia, or even normal glands. Preoperatively depressed renal function normalized in about 50% of cases, as assessed by the desmopressin test. No patient had paralysis of the recurrent laryngeal nerve, and all were normocalcaemic during follow-up. Parathyroid surgery should be considered for this category of patients, although it is very difficult to distinguish between those who stand to benefit and those who do not.

Adult↗

PubMed1986

[Comparison of indomethacin and ketobemidone as analgesics in acute cholecystitis].

In an open, randomized prospective clinical trial the analgesic effect of indomethacin and ketobemidon was compared in 67 patients with acute cholecystitis (28 received 5 mg ketobemidon and 39 received 50 mg indomethacin). Both drugs showed a good and significant pain relief, exhibiting no significant difference in the analgesic effect and no serious adverse reactions. It was concluded that indomethacin administered intravenously is an alternative to ketobemidon intravenously in the treatment of pain resulting from acute cholecystitis and may offer some advantages.

Acute Disease↗

PubMed1985

Prevention of post-operative infection in appendicectomy by single dose intravenous metronidazole. An open prospective randomised study.

In an open prospective randomized study of appendicectomy, single-dose (1 g) intravenous metronidazole prophylaxis (and continued metronidazole plus nalidixic acid in perforated appendices) resulted in a lower overall post-operative infection rate (1.4%) than no prophylaxis and doxycycline therapy in the case of perforation (16%, p less than 0.025). In patients with an unperforated appendix no infections occurred after single-dose metronidazole prophylaxis as opposed to 8.2% infections in untreated controls (p less than 0.025).

Adolescent↗

PubMed1985

Single-dose intravenous metronidazole v. doxycycline prophylaxis in colorectal surgery. An open prospective, randomized trial.

In an open prospective, randomized study of antimicrobial prophylaxis in colorectal surgery, using a single intravenous dose, metronidazole (1 g) was more effective than doxycycline (0.2 g). The difference in infection rates (2/41 = 5% v. 7/33 = 21%) was statistically significant. Prolonged administration of either agent (2-7 days) yielded results comparable to those with single doses. Five emergency cases were admitted to the study. In two of them, a metronidazole-based therapeutic regimen prevented postoperative infection, whereas infection occurred in all 3 patients given doxycycline therapy. The total infection rate after elective surgery was 4% with metronidazole and 25% with doxycycline prophylaxis. The infections in the metronidazole group were superficial and caused by Escherichia coli, whereas half of the infections in the doxycycline group were intra-abdominal and due to intestinal aerobic and/or anaerobic bacteria. In contrast to doxycycline, therefore, metronidazole prevented postoperative anaerobic infection and was associated with low incidence of aerobic infection.

Adult↗

PubMed1984

Biliary microflora in acute cholecystitis and the clinical implications.

A prospective bacteriologic investigation was made in 43 consecutive patients (mean age 63 years) operated on for acute cholecystitis. Gallbladder bile and wall were cultured, using four methods and with special attention to optimal anaerobic technique. Cultures were positive in 72% of the patients, yielding a wide variety of species (21 species among 48 isolates). Anaerobes constituted 23% of the isolates. Cultures from gallbladder bile and from gallbladder wall gave almost identical results, as did sampling at the beginning and at the end of cholecystectomy. Bactibilia was found in all patients operated on within 48 hours after the onset of symptoms. Bactibilia and postoperative septic complications showed statistically significant correlation with high patient age. Bactibilia and gallbladder gangrene were significantly correlated with preoperative temperature greater than 38.5 degrees C. There was coincidence of strains isolated from local wound sepsis and from peroperatively sampled gallbladder bile. Adequate preoperative or peroperative antibiotic therapy according to susceptibility testing was associated with significantly reduced rate of postoperative septic complications. The study indicates that bacteria are present early in the course of acute cholecystitis and that they are causally important for postoperative morbidity and mortality.

Acute Disease↗

PubMed1983

Separation of sutured tendon ends when different suture techniques and different suture materials are used. An experimental study in rabbits.

Calcaneal tendons in rabbits were divided and then sutured with varying suture techniques and suture materials. The separation of the tendon ends after suturing was registered with an X-ray technique--the tendon ends being identified by thin steel wires. Independently of the suture techniques and the suture materials a biphasic separation of the tendon ends was registered. The first separation took place during the first 4-5 days while the second separation began after 20-24 days. A small initial separation seems to indicate that the tendon suture used is adequate. The initial separation can therefore be used to evaluate a suturing technique and how the result is influenced by the suture material used. In the present study we could show that steel wire was ideal for a Bunnell suture. Prolene and Ethiflex cannot be recommended. A suture technique with a single short loop gave good results with all suture materials. Dexon ligatures placed around the tendon ends according to Schink in order to prevent the strands of the suture from cutting the tissue, did not reduce the initial separation. When a complex suture technique, like a Bunnell suture, is used the physical properties of the suture material influence the result. With a simple suture technique, a single short loop, good results can be achieved with every suture material.

Animals↗

PubMed1979

Influence of 1,25-dihydroxycholecalciferol on parathyroid activity in patients with primary hyperparathyroidism.

Parathyroid morphology and blood chemistry were studied in five patients with primary hyperparathyroidism treated with 1,25-dihydroxycholecalciferol (1,25-DHCC) for 2 to 11 days before planned operation. Before the institution of treatment all patients were hypercalcemic, whereas the serum immunoreactive parathyroid hormone (iPTH) concentration either was elevated or normal. During the treatment the urinary phosphate excretion was significantly increased, whereas the calcium excretion and the serum concentrations of calcium and phosphate were unaffected or only slightly changed. Serum iPTH decreased during the first days of treatment, but returned then to increased levels close to the pretreatment ones. The treatment was tolerated well by the patients. Light and electron microscopy of the removed parathyroid glands disclosed one adenoma in each of the five patients, the other glands exhibiting either a slight hyperplasia or a normal appearance. Both the adenomatous and the non-adenomatous parathyroid tissue showed a predominance of dark chief cells and three of the adenomas exhibited a varying number of atrophic and oxyphil cells. The non-adenomatous glands were composed of atrophic and dark chief cells. Signs of low functional activity were ultrastructurally observed in the parathyroid parenchymal cells. It is suggested that 1,25-DHCC treatment of patients with primary hyperparathyroidism inhibits parathyroid hormone secretion.

Adult↗

PubMed1978

Treatment of ureteral colic with intravenous indomethacin.

A randomized prospective double-blind study of the analgesic effect of 50 mg. intravenous indomethacin, a prostaglandin synthesis inhibitor, was done on 47 consecutive patients with acute ureteral colic. The placebo used was 5 mg. intravenous riboflavin because of the same color as indomethacin. Indomethacin provided complete relief in 78 per cent of the cases, while riboflavin provided relief in 30 per cent. The difference is statistically significant. No side effects were observed with indomethacin.

Clinical Trials as Topic↗

PubMed1978

The influence of 1,25-dihydroxycholecalciferol on the ultrastructural organization of skeletal muscle fibres. Morphometric analyses on vitamin D deficient or calcium deficient growing rats.

Ultrastructural evidence was obtained from vitamin D deficient and calcium deficient rats that the sarcoplasmic reticulum (SR) is involved in the intracellular calcium transport of the muscle cell. In the absence of vitamin D there was a relative decrease in SR volume and a compensatory increase in mitochondrial volume. Administration of exogenous doses of 1,25-dihydroxycholecalciferol significantly increased SR volume, while mitochondrial volume correspondingly decreased. This supports the hypothesis that the production of calcium binding proteins within the SR is influenced by active metabolites of vitamin D.

Animals↗

PubMed1977

Extrahepatic obstruction of the portal vein with bleeding from the gallbladder. Report of a case.

A case of extrahepatic obstruction of the common bile duct and the portal vein by a retroperitoneal neurolemmoma is described. In the initial stages portal hypertension with hepatofugal collaterals and bleeding from oesophageal varices existed. Then gradually, hepatopetal anastomoses developed, partly via veins in the wall of the gallbladder. Such venous collaterals tend to reduce the portal hypertension, but may cause bleeding from the gallbladder.

Adolescent↗

PubMed1975