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Biomedical subjects

E Kullman

Publications and source records attributed to E Kullman.

30 records · Page 2Linked to original sources
PubMed1991

Long-term follow-up of patients with gallbladder in situ after endoscopic sphincterotomy for choledocholithiasis.

Endoscopic sphincterotomy (EST) was performed on 148 patients with common bile duct stones and intact gallbladder. The duct was cleared in 130 cases (88%). Immediate complications occurred in 23 patients (15.5%), six of whom died. In 118 of the 139 patients discharged from the hospital, the bile ducts were cleared and the gallbladder in situ. The median observation time in these 118 cases was 42 (1-97) months, during which 13 (11%) were cholecystectomized because of symptoms or acute complications due to remaining gallbladder stones, and 49 (42%) died 2-87 (median 24) months after EST. The probability (life-table) of remaining free from cholecystectomy-requiring symptoms or complications was 0.87 after 42 months. There was no association between nonfilling of the gallbladder at ERC and subsequent problems with gallbladder stones. EST for choledocholithiasis with retained gallbladder is justified for elderly and frail patients. Indefinite postponement of cholecystectomy may be warrantable, restricting surgery to patients with symptoms from gallbladder stones. This most frequently means within 2 years after EST.

Acute Disease↗
PubMed1989

Long-term follow-up after endoscopic management of retained and recurrent common duct stones.

Endoscopic sphincterotomy (EST) was attempted on 128 patients because of retained or recurrent common bile duct stones. The duct was cleared in 118 cases (92%). Early complications arose after 27 (16.5%) of 164 sphincterotomies, with haemorrhage most common. Emergency laparotomy was performed in four cases. There were four deaths within a month of EST, two of them directly attributable to EST. In seven of the 118 patients with successful EST late complications (stenosis and/or recurrent stone) appeared during a median follow-up of 57 (range 24-101) months (after less than 2 years in 6 cases). Restenosis and new stones could usually be endoscopically treated. Ascending cholangitis was not a problem, provided that the bile flow was unobstructed. EST is relatively safe, and must now be considered the procedure of choice for postcholecystectomy choledocholithiasis especially in elderly or high-risk patients. EST in young, fit patients is more controversial, and requires further detailed longitudinal analyses.

Adult↗
PubMed1988

Gallbladder cancer: current status in clinical practice.

A total series of 68 unselected patients with gallbladder cancer, diagnosed during 1972 to 1981, was studied retrospectively. In 61 cases (90%), the diagnosis was histologically verified. The cardinal symptoms were local pain (87%), loss of weight (53%), and jaundice (59%). The diagnosis was established after autopsy in 22 patients (32%), and exploratory laparotomy in 22 patients (32%). Palliative surgery was carried out in 26 patients of whom seven (27%) died postoperatively. Only one patient, with an incidentally detected cancer at routine cholecystectomy, was treated radically. Four out of nine patients died within one month after PTC-drainage. The mean survival time for the whole series was 2.9 months. The longest survival was 21 months. Considering the increasing incidence of gallbladder cancer in Sweden, as well as of other cancers of the biliary system, these findings emphasize the need for intensified research. An epidemiological approach studying the correlation of gallbladder cancer with the changing trend of gallstone disease and its treatment would perhaps be fruitful.

Adult↗
PubMed1987

Gastric carcinoid associated with the syndrome of hypergastrinemic atrophic gastritis. A prospective analysis of 11 cases.

The prevalence of gastric carcinoid in fundic atrophic gastritis is probably greater than previously recognized. To help elucidate the clinicopathology of this syndrome, we report a series of 11 patients with solitary or multicentric carcinoid tumors. In these patients, basal gastrin levels and density of fundic mucosal endocrine cells were greater than that for patients with uncomplicated fundic atrophic gastritis (p = 0.02 and p = 0.002, respectively). The polypoid tumors, of which the largest measured 30 mm, frequently showed characteristic endoscopic features. They were all situated in the fundic mucosa, which showed micronodular endocrine cell hyperplasia. Small, endoscopically evident tumorlets, or "early carcinoids," limited to the lamina propria were observed in some patients. These lesions may represent intermediate stages between micronodules and invasive carcinoids, all of which infiltrated at least into the muscularis mucosae of the gastric wall. Although some consistent characteristics features were noted, there were structural variations. The cells were argyrophil but nonargentaffin and did not stain with conventional mucus stains. They did not stain significantly for carcinoembryonic antigen (CEA). The secretory product of these tumors remains to be identified. Ultrastructurally, some tumors were mainly composed of enterochromaffinlike (ECL) cells, but in other tumors most of the cells could not be classified.

Carcinoid Tumor↗
PubMed1987

Drainage by endoscopic endoprosthesis in biliary obstruction. A report of initial experience.

Biliary drainage by endoscopic, transpapillary insertion of endoprosthesis was attempted in 38 patients with obstructive jaundice and was successful in 25. The procedure was palliative in 17 cases and preoperative in eight. Benefit was obtained by ten of the former and seven of the latter patients, while in eight the serum bilirubin did not fall despite adequate catheterization. In two intubated patients with recurrent nonterminal jaundice, the endoprostheses were repeatedly changed; the median time to clogging was 51 (8-77) days. Cholangitis developed in 15 of the total 38 patients. Antibiotic prophylaxis, though not routinely used, is recommended for all cases with biliary stasis. Unimpeded bile flow was not ensured with 7 F endoprostheses, whose patency time tended to be short. By using sizes 10-12 F the authors hope to improve bile flow, thereby diminishing obstruction, stagnation and infection and prolonging patency. In selected cases the method may offer an alternative to the percutaneous approach, and possibly also to surgical bypass.

Aged↗
PubMed1986

Pancreatic cancer.

During 1972-1981, a total of 177 individuals were diagnosed as having pancreatic cancer at the Central Hospital of Eskilstuna, Sweden. The mean crude incidence rate was 15.0 X 10(-5) year-1. Only 56% of the patients had the diagnosis made prior to death. 63% of the cancers had advanced beyond therapeutic range. Symptoms compatible with upper abdominal disease for more than six months prior to diagnosis occurred in 27% of the cases, and 15% had sought medical advice more than 6 months prior to diagnosis. Radical surgery was performed on 5 patients of whom one died postoperatively, and 61 patients (34%) underwent palliative treatment. The postoperative mortality rate after palliative treatment was 28%. The mean survival time for the whole series was 2.6 months, and 13% survived for one year. One patient survived for 2 years after palliative treatment. It is concluded that the only means by which the prognosis for patients with pancreatic cancer may be improved is to define populations at high risk and to develop more specific and sensitive diagnostic methods.

Adult↗
PubMed1985

Endoscopic sphincterotomy in the treatment of choledocholithiasis and ampullar stenosis. Experience with 202 patients.

Endoscopic sphincterotomy (EST) was performed on 202 patients (265 EST) in the 5-year period 1978-1983 because of choledocholithiasis or benign stenosis of the ampulla of Vater. The indications for EST in choledocholithiasis included residual or recurrent stone(s) in 80 cholecystectomized patients, and 96 had choledocholithiasis with the gallbladder in situ. Ductal calculi passed spontaneously after EST in 87 cases (50%) and were actively extracted in 73 (41%). Ductal clearance failed in 16 patients. The overall success rate thus was 91%. Ampullar stenosis was successfully treated in 26 patients. Sphincter stenosis after EST was diagnosed in one patient. Immediate complications of EST arose in 31 patients (11.7%), one of whom died. Emergency laparotomy was required in three cases (1.1%). EST with or without stone extraction is a relatively safe procedure for managing choledocholithiasis in high-risk patients before cholecystectomy is considered, and also for stones retained or reformed after cholecystectomy. Endoscopic treatment may offer appreciable clinical and financial benefits by reducing morbidity and mortality rates and shortening hospitalization and convalescence time.

Adult↗
PubMed1984

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with jaundice and suspected biliary obstruction.

During a 4-year period (1978-1982), 206 patients were examined with endoscopic retrograde cholangiopancreatography (ERCP) because of jaundice with suspected biliary obstruction. The total of examinations was 223. Duodenoscopy with ERCP gave a positive primary diagnosis in 160 cases (78%), six (4%) of which later proved to be incorrect. Extrahepatic obstruction could be excluded in 16 patients with normal cholangiogram (8%). Clinically relevant information thus was obtained in 176 cases (85%). The main cause of extrahepatic obstruction was common bile duct stone(s), which were found in 73 patients. Immediate endoscopic sphincterotomy was performed in 64 of them and cleared the duct of stones in 54 (84%). Benign stenosis of the ampulla of Vater was relieved with endoscopic sphincterotomy in six patients. Malignant bile duct obstruction was diagnosed in 56 patients, and in three of them an endoprosthesis for internal drainage of the biliary tract was endoscopically inserted. Immediate complications after ERCP without endoscopic sphincterotomy occurred in 5 of 136 patients (4%), one of whom died. The authors conclude that ERCP is a rapid, reliable and safe diagnostic method in patients with extrahepatic biliary obstruction.

Adult↗
PubMedDate not supplied

Bacteremia following diagnostic and therapeutic ERCP.

The occurrence of bacteremia in association with diagnostic or therapeutic ERCP was studied in 180 patients undergoing a total of 194 examinations. Nineteen (15%) of 126 diagnostic procedures and 18 (27%) of 68 therapeutic procedures were associated with bacteremia (p less than 0.1). Nine patients had polymicrobial bacteremia and a total of 16 species were detected. Different streptococci, mainly alpha-hemolytic, were the most common bacteria which were identified in 38% of the bacteremic patients. There were no significant differences with regard to the occurrence of fever, pancreatitis, or septic complications between the diagnostic and therapeutic groups of patients. Neither did the complication rate in patients with bacteremia differ from that in patients without bacteremia, whether the procedure was diagnostic or therapeutic. Complication rates did not differ between patients with and patients without pancreaticobiliary obstruction. However, the majority of patients with biliary stasis had drainage with relief of the obstruction at the time of the diagnostic ERCP. We conclude that general routine antibiotic prophylaxis is not indicated in patients undergoing diagnostic or therapeutic ERCP. The question whether such prophylaxis should be given with certain diagnoses or treatments, or in patients with valvular heart disease, remains to be answered in controlled randomized studies.

Aged↗
PubMedDate not supplied

Dual versus triple therapy in eradication of Helicobacter pylori.

BACKGROUND/AIMS: Duodenal ulcers should be treated by eradication of Helicobacter pylori. This study compared the efficacy of a proton pump inhibitor together with one or two antibiotics in eradication therapy. METHODOLOGY: 177 patients who were H. pylori positive were randomized to receive 14 days of either: lansoprazole 30 mg bd and amoxicillin 1 g bd (LA), omeprazole 20 mg bd and amoxicillin 1 g bd (OA) or lansoprazole 30 mg bd, amoxicillin 1 g bd and clarithromycin 500 mg bd (LAC). The efficacy was assessed at four weeks and at six months after the end of treatment. Biopsies were taken for culture and bacterial sensitivity testing at inclusion and at four weeks after the end of treatment. RESULTS: 149 patients were evaluated for efficacy. The eradication rate was significantly higher in LAC (96%) compared to LA (51%) and OA (64%) treatments (P < 0.001). At baseline 17%, 21% and 19% of the patients in the LA, OA and LAC groups, respectively, were resistant to metronidazole and only one patient was resistant to clarithromycin. Post-treatment, four patients had acquired metronidazole resistance. CONCLUSIONS: LAC is more effective than LA and OA for eradication of H. pylori in duodenal ulcer disease.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMedDate not supplied

Bacteremia associated with extracorporeal shockwave lithotripsy of gallbladder stones.

BACKGROUND/AIMS: The possible induction of bacteremia by extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones was studied. MATERIALS AND METHODS: Seventy-six patients undergoing a total of 107 ESWL treatments were studied. RESULTS: Twenty-four (22%) of the 107 treatments were associated with bacteremia. Staphylococcus epidermidis was cultured during and/or after 23 (96%) of the treatments associated with bacteremia. The ESWL-induced tissue damage of the skin in the pass-way of the shock-waves was the most likely cause of bacteremia in these patients. There was no correlation between the occurrence of bacteremia and the age or body mass index of the patients. Neither was there any correlation of bacteremia related to the duration of the treatment, the number of shock waves, the energy delivered, the stone volume or the occurrence of calcified stones. No patient developed sepsis or endocarditis. Transient fever shortly after treatment was recorded in 5 patients (5%), one of whom had bacteremia. CONCLUSIONS: Routine antibiotic prophylaxis is not indicated in patients undergoing ESWL for gallbladder stones. The question whether such prophylaxis should be given to patients at special risk, for instance patients with artificial heart valves or known valvular heart disease, remains to be answered in larger controlled and randomized studies.

Antibiotic Prophylaxis↗