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Biomedical subjects

E Haglind

Publications and source records attributed to E Haglind.

At least 37 records · Page 2Linked to original sources
PubMed1996

Vertical banded gastroplasty by laparoscopic technique in the treatment of morbid obesity.

From October 1993 through May 1994, 38 consecutive morbidly obese patients underwent a laparoscopic vertical banded gastroplasty (VBG). During the operation a gastric window was made by a 25-mm circular stapler; and the vertical staple line, establishing the gastric pouch, was constructed by using a 60-mm, four-row linear stapler. The outflow stoma was reinforced by a Gore-Tex band and calibrated to have an internal diameter of 9 mm. Three patients had to be converted to open surgery during the initial laparoscopic procedure because of insufficient operative access. Another three patients had to be reoperated during subsequent postoperative courses, one laparoscopically to reinforce a vertical staple line defect caused by a transected nasogastric tube, another because of an open reoperation during the first postoperative day for a rupture in the vertical staple line, and, finally, a patient was reexplored because of the present of postoperative fever with a left-sided pleuropneumonia and subphrenic accumulation of fluid. However, during the operation no leakage or any other local complications were detected. The subsequent postoperative courses were uneventful in all these patients. Compared with the reference group comprising the latest consecutive 17 obese patients operated with open VBG before the introduction of the laparoscopic technique, the laparoscopy group had less postoperative pain and had mobilization sooner. In the latter group, we recorded an improved respiratory status during the early postoperative period, as reflected by increased oxygen saturation and peak exspiratory flow rates as well as a lower body temperature. In conclusion, laparoscopic VBG is technically feasible and can be safely performed. Our early postoperative experiences suggest that these patients have a shorter and less cumbersome postoperative recovery period compared with conventionally operated obese patients. The long-term follow-up of these patients will determine whether these initial advantages of the laparoscopic approach are corroborated by comparable effects on weight control.

Adult↗
PubMed1995

The yield of flexible sigmoidoscopy and double-contrast barium enema in the diagnosis of neoplasms in the large bowel in patients with a positive Hemoccult test.

BACKGROUND AND STUDY AIMS: In an ongoing screening study of 68,306 patients for early detection of colorectal cancer, those with a positive Hemoccult II test (H2) were examined with a flexible sigmoidoscope (60 cm) (FS) and double-contrast barium enema (DCE). The aim of this study was to compare the results of FS and DCE examinations in the rectum and the sigmoid colon, and to evaluate the benefit of DCEs. PATIENTS AND METHODS: 1831 FS and DCE examinations were performed on the basis of positive H2 tests (90% acceptance rate for positive Hemoccult tests). The radiologists were unaware of the endoscopic findings. One hundred and thirty-five patients underwent total colonoscopy due to abnormalities found on FS or DCE, or both. All patients were followed-up through various Swedish cancer registers (range: 50-145 months). RESULTS: The sigmoidoscope was fully introduced in 71% of cases, and the mean time for the examination was 5 minutes. The combination of FS and DCE detected 235 adenomas of 1 cm and more, and 81 cancers which were in Dukes stages A (n = 29), B (n = 22), and C (n = 23). Twenty-one cancers (26%) and 24 adenomas (10%) identified on DCE were above the rectosigmoid area. The rate of overlooked adenomas (> or = 1.0 cm) and cancers was 22 and five for FS in the rectosigmoid area, and 55 and 15, respectively, for DCE. Adenomas found in the rectosigmoid area were only rarely associated with more proximal adenomas of 1 cm and more (1%). CONCLUSIONS: This approach-screening by FS and DCE, and selective use of colonoscopy in case of abnormalities-leads to the diagnosis of significant colonic tumors (larger adenomas and cancers) in 17.7% of cases; only two of eighty-three cancers (2.4%) were overlooked with this method.

Adenoma↗
PubMed1995

The effect of recombinant human IGF-I on protein metabolism in post-operative patients without nutrition compared to effects in experimental animals.

This study has evaluated the effects of recombinant human insulin-like growth factor I (rhIGF-I) to moderately stressed post-operative patients provided with dextrose as the only exogeneous substrate. Thirty patients who underwent elective colorectal surgery were randomized to receive either rhIGF-I (80 micrograms kg-1 bw) subcutaneously twice daily or placebo injections in a double-blind parallel group design. Nitrogen balance, urinary 3-methyl-histidine excretion plasma growth hormone (GH), serum cortisol, IGF-I binding proteins (IGFBP-1,3), glomerular filtration rate, plasma amino acid concentrations and whole-body energy expenditures were measured as effector variables during days 1-5 post-operatively. Animal and isolated tissue experiments were performed as additional control experiments to confirm cellular effectiveness of the recombinant material. rhIGF-I increased significantly the glomerular filtration rate and prevented the adaptive decrease in whole-body energy expenditure in response to partial starvation in the postoperative period. Serum and plasma concentrations of IGFBP-1,3 cortisol, blood glucose and amino acids were not significantly influenced by rhIGF-I administration, while plasma GH levels decreased significantly as expected. rhIGF-I had no effect on either nitrogen balance or protein breakdown (3-methylhistidine excretion) in post-operative patients on dextrose supplementation only, although plasma concentrations of IGF-I increased from 130-140 ng mL-1 to a range of 300-450 ng mL-1. In contrast, IGF-I stimulated the synthesis of both globular and myofibrillar proteins (+50%, P < 0.01), when given as a single dose (100 micrograms kg-1) 2 h before measurements of protein synthesis in skeletal muscles of overnight fasted adult mice. This stimulatory effect by IGF-I (1 microgram mL-1) was also confirmed by measurements of skeletal muscle protein synthesis in vitro (+40%, P < 0.05). Orally re-fed mice had a normal transcription of IGF-I mRNA in skeletal muscle cells, while overnight fasted mice showed a trend to down-regulated transcription. Our results demonstrate that rhIGF-I has several significant physiological effects, without major side-effects, when supplied to partially starved patients in the post-operative phase. The lack of a whole-body nitrogen sparing effect by rhIGF-I alone to post-operative patients is not clear, but was most likely explained by subnormal plasma concentrations of amino acids.

Aged↗
PubMed1995

Factors associated with participation in screening for colorectal cancer with faecal occult blood testing.

BACKGROUND: Factors associated with attending screening for colorectal cancer with faecal occult blood testing was studied. METHODS: Sixty-eight per cent of 34,144 subjects participated in the primary screening and/or rescreening in a randomized screening study. The mortality and causes of death in the two groups were studied. A sample of the subjects received a questionnaire, in which they were asked about their reaction to the invitation. A statistical sample was called for a telephone interview. RESULTS: The mortality among the non-attenders was higher than among the attenders (p < 0.001), which might reflect a higher morbidity among the non-attenders. The mortality was equal in the test and control groups. There was no difference among the attenders and non-attenders who had a full or 50% pension. Among immigrants the attitude to screening was less positive among those born in 1918 but was the same as that of the whole group among those born in 1929. Significantly fewer persons among the non-attenders than among the attenders could be reached for a telephone interview (p < 0.001). CONCLUSION: There is a possibility that the compliance can be increased. The non-attenders' attitude to screening was more negative than that of the attenders.

Aged↗
PubMed1995

Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. A prospective randomized study of metoclopramide and transdermal hyoscine.

OBJECTIVE: To compare the antiemetic effects of metoclopramide and hyoscine in patients after laparoscopic cholecystectomy. DESIGN: Prospective, randomised trial. SETTING: University hospital, Sweden. SUBJECTS: 100 consecutive patients median age 49 years (range 21-79) of whom 9 were withdrawn after randomisation. INTERVENTIONS: Patients were randomised to receive either four doses of metoclopramide 10 mg intravenously starting at the induction of anaesthesia (n = 44), or hyoscine transdermally through a patch placed behind the ear at 0600 h on the day of operation (n = 47). MAIN OUTCOME MEASURES: The incidence of nausea and vomiting. RESULTS: Metoclopramide was significantly more effective at preventing both nausea and vomiting (20/44 (45%) compared with 32/47 (68%), p < 0.05, and 10/44 (23%) compared with 21/47 (45%), p < 0.05). Women were significantly more likely to become nauseated than men (46/66 (70%) compared with 5/25 (20%), p < 0.001). Two patients in the metoclopramide group developed dizziness, and one patient in the hyoscine group had a disturbance of vision. About 20% in each group required additional antiemetic treatment. The median hospital stay in both groups for patients who did not develop complications was 2 days. CONCLUSION: There was a high incidence of nausea and vomiting after laparoscopic cholecystectomy even after treatment with metoclopramide. Further measures are indicated, particularly for women.

Administration, Cutaneous↗
PubMed1994

Follow-up after screening for colorectal neoplasms with fecal occult blood testing in a controlled trial.

PURPOSE: The aim of this study was to investigate the number of new colorectal neoplasms during the first seven years after the end of rescreening in a prospective randomized screening study. METHODS: 27,700 inhabitants of Göteborg born between 1918 and 1922 (60-64 years old) who were randomly allocated to a control or a test group in 1982 were followed up. All people in the latter group were offered six fecal occult blood tests and rescreening 16 to 22 months later. RESULTS: One hundred one carcinomas were diagnosed in the screened group and 128 in the control group during the seven years of follow-up. The number of carcinomas in the test group was half that in the control group during the first two years of follow-up, but equal during the rest of the follow-up period. The distribution of carcinomas according to Dukes classification was significantly better among the participants compared with the refusers (P < 0.02) but there was no difference in the Dukes distribution when the test and control groups as a whole were compared. The number of adenomas in the two groups during seven years of follow-up was the same. CONCLUSION: The results indicate that screening and rescreening of a population has little influence upon the stage of the carcinomas in the test group compared with a control group during the first seven years of follow-up. The number of carcinomas was higher in the control than in the test group during the follow-up, probably because of a lead time effect during the screening.

Adenoma↗
PubMed1994

Changes in circulating plasma met-enkephalin concentrations in feline intestinal ischemia--reperfusion.

Plasma met-enkephalin-like immunoreactivity (MLI) levels were determined in cats before, during and after 90 min of intestinal ischemia followed by reperfusion and compared with the levels in control cats. Blood pressure and heart rate were registered and small intestinal mucosal lesions were graded. In control animals, the circulation was stable and there were no mucosal injuries. In the shock group, blood pressure decreased, heart rate increased and severe mucosal lesions were found. The circulating MLI levels were significantly higher 30 min after reperfusion of the ischemic intestine in the shock group than in the control group. There were correlations between MLI and tachycardia and hypotension respectively. Met-enkephalin was released in shock animals after reperfusion of the ischemic intestine and may explain naloxone responsiveness in intestinal shock models.

Animals↗
PubMed1994

Results of screening, rescreening, and follow-up in a prospective randomized study for detection of colorectal cancer by fecal occult blood testing. Results for 68,308 subjects.

All 68,308 inhabitants of Göteborg born between 1918 and 1931 were randomly divided into a test and a control group. The subjects in the test group were invited to perform Hemoccult II fecal occult blood testing on 3 days and to repeat the test after 16 to 24 months. In the prevalence screening 21,347 (63%) performed the test, and in the rescreening 19,991 (60%). Investigation of the 942 (4.4%) with positive tests in the prevalence screening showed 47 cancers and 129 subjects with adenomas > or = 1.0 cm. In the rescreening 5.1% had a positive test, and 34 cancers and 122 subjects with adenomas (> or = 1.0 cm) were found among those. Cancer had also been diagnosed in 19 subjects in the interval between the two screening occasions and in 15 subjects among the non-responders. Forty-four cancers had been diagnosed in the control group during the same period. Cancers detected by screening were at a less advanced stage than in the control group. It is too early to show any effect of screening on mortality from colorectal cancer.

Adenoma↗
PubMed1994

Effects of antioxidants and PAF receptor antagonist in intestinal shock in the rat.

In a model of intestinal ischemia-reperfusion resulting in hypotension, mucosal lesions in the small intestine and mortality, the effects of a combination of superoxide dismutase (SOD) and catalase (cat) or a PAF receptor antagonist were tested. Intestinal ischemia was induced in rats and continued for 60 min. After this, the intestine was reperfused. A PAF receptor antagonist, BN 52021, was given 50 min before ischemia in one group, and SOD + cat was given 10 min before reperfusion in one group. One group received normal saline and one group were controls. Blood pressure, mucosal lesions, plasma volume, and endotoxin in plasma were determined up to 3 hr after reperfusion. Mortality was determined over 4 days. Endogenous endotoxin was not found in any of the groups, but the first types of SOD and cat used were contaminated with endotoxin, resulting in exogenous endotoxemia in animals which received those substances. Later endotoxin-free enzymes were used. Neither SOD + cat nor PAF antagonist had any effect on the hypotension or mucosal lesions. Plasma volume remained at the level of the control group after administration of either regimen. Mortality decreased in the group that received SOD + cat. The effects of SOD + cat indicate that free radicals were released in this model at reperfusion, and the effects of the PAF receptor antagonist indicate that PAF participates in membrane damage, but is an intermediary mechanism in the shock model used. The clearance of infused endotoxin from plasma was less effective in the shocked animals, possibly due to a shock effect on reticuloendothelial system (RES).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Failure of hypertonic saline to resuscitate intestinal ischemia shock in the rat.

The effects of resuscitation with hypertonic saline (HS), administered as a bolus injection or infusion, were studied in a model of intestinal ischemia shock in rats. The model is characterized by severe intestinal mucosal lesions, release of cardioinhibitory substances and endogenous opioid peptides, and it results in high mortality rates. The blood pressure improved after HS given as an infusion for 1 h. The effects on blood pressure of HS given as a bolus and of normotonic saline (NS) were not significant. Plasma volume was not different from unshocked control animals in either HS infusion or NS infusion groups 2 and 4 h after infusion. Liver metabolic consequences of intestinal shock did not differ comparing the HS and NS groups, and the same result was found concerning the mucosal lesions in the small intestine. The 7-day survival decreased in the HS infusion group (14%) compared to untreated shock (46%) or NS infusion (54%) groups. We conclude that HS failed to resuscitate intestinal ischemia shock. These experiments indicate that HS treatment could even, in contrast to previous reports on hemorrhagic shock, be disadvantageous or dangerous in shock states characterized by extensive tissue injury.

Animals↗
PubMed1992

Effects of continuous naloxone infusion in intestinal ischemia shock in the rat.

The effects of continuous naloxone infusion on the response to intestinal ischemia-reperfusion were studied in a rat model. Naloxone was given as a bolus injection (2 mg/kg bw) followed by a continuous infusion (4 mg/kg bw/h) starting before (-10 min) intestinal ischemia was applied (0-60 min) and continuing 2 h after reperfusion of the intestine. Blood pressure, acidosis and survival were determined. Saline-infused shocked rats and untreated shocked rats served as comparisons and non-shocked animals as controls. Blood pressure was slightly higher before and during the continuous naloxone infusion but did not differ after reperfusion in the three shock groups. Acidosis was less pronounced in naloxone compared to untreated shocked rats. Survival rates were significantly higher in naloxone-treated shocked rats compared to untreated shock and significantly lower in saline treated shocked rats compared to non-shocked controls. In conclusion a naloxone effect on acidosis and survival in shock after intestinal ischemia and reperfusion is possible.

Acid-Base Equilibrium↗
PubMed1990

Value of retesting subjects with a positive Hemoccult in screening for colorectal cancer.

Within a prospective randomized screening study for early detection of colorectal cancer with rehydrated Hemoccult II test, the possibility of increasing the specificity of the test by retesting patients with an initially positive Hemoccult II test was investigated. Of those offered the test 3561 (62.6 per cent) returned it and it was positive in 210 cases (5.9 per cent). The repeat test was performed by 184 patients and was positive in 68 (1.9 per cent). All those with a positive initial test had rectosigmoidoscopy to 60 cm and a double contrast enema. A carcinoma was found in one in seven patients with a positive retest but in only one in 100 patients with a negative retest (P less than 0.001). The specificity of the test was, therefore, increased from 95 per cent to 98 per cent and the sensitivity was unchanged. Rescreening was offered at a later date and increased numbers were available: 7147 patients returned the test and 369 (5.2 per cent) were positive. The test was repeated in 360 patients and 118 (1.7 per cent) were positive. A colorectal neoplasm was found in one in three of those with a positive repeat test, compared with one in seven of those with a negative repeat test. In conclusion, screening for early detection of colorectal cancer with a rehydrated Hemoccult II test may be followed by investigation of only those patients with a positive retest. Such a procedure will reduce the work-load by 60 per cent without reducing sensitivity.

Barium Sulfate↗