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Biomedical subjects

G Liedberg

Publications and source records attributed to G Liedberg.

At least 19 recordsLinked to original sources
PubMed2000

Factors of importance for work disability in women with fibromyalgia.

OBJECTIVE: To identify factors of importance for women with fibromyalgia (FM) to continue working despite the limitations imposed by the symptoms. METHODS: A mail questionnaire with questions regarding social background, symptoms, sickness benefits, work situation, work conditions and adjustments, opinions regarding own work ability, and satisfaction with the situation was sent to 218 consecutive women seen at a university pain or rheumatology clinic. Answers were obtained from 176 women. RESULTS: Pain, poor quality sleep, abnormal tiredness, muscle stiffness, and increased pain after muscle exertion were frequently reported symptoms. Fifty percent of the women were employed, 15% full-time. Twenty-three percent reported FM as the reason for not working. The work situation had been changed for 58% of the working women, and 80% counted on being able to continue working. CONCLUSION: Work disability is a serious concern in FM, and the majority of women with FM have limitations in their ability to work. Our results indicate that individual adjustments in the work situation need to be made and that women who have found a level matching their ability may continue to work and find it satisfactory. Early intervention in the work situation is recommended.

Adult↗
PubMed1995

Hands-on endoscopy training: an evaluation of the SADE endoscopy course. Scandinavian Association of Digestive Endoscopy.

The Scandinavian Association of Digestive Endoscopy course in advanced practical endoscopy has been arranged on a regular basis since 1980, representing a joint Scandinavian effort to offer hands-on endoscopy training with expert supervision at major endoscopy centers. The course has been aimed at gastroenterologists with previous endoscopic experience, focusing on special techniques, practical hints and expert solutions in special cases. Three days of practical training throughout Scandinavia are completed with two days of review lectures, case reports and special techniques. An inquiry among previous course participants indicates that the course has indeed been of practical value for their daily work, and that personal training as well as watching "experts at work" were useful for their ensuing endoscopic practice. The course model does, however, require close co-operation with the endoscopy units hosting the practical part of the course.

Curriculum↗
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

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

Endocrine cell proliferation and carcinoid development: a review of new aspects of hypergastrinaemic atrophic gastritis.

The accumulating evidence of an association between antrum-sparing hypergastrinaemic atrophic gastritis, frequently associated with pernicious anaemia, and the occurrence of gastric carcinoid tumours is briefly reviewed. The development of argyrophil cell carcinoid tumours in the atrophic fundic mucosa seems to be related to argyrophil cell hyperplasia caused by hypergastrinaemia. Epidemiologic considerations indicate that the gastric carcinoid generally is underdiagnosed and that the incidence of this tumour is higher than previously recognized. The clinical relevance of minute gastric carcinoids, or endocrine cell 'adenomas', is obscure. However, larger tumours should be regarded as potentially malignant. These findings are relevant to the aspect of long-term medically induced achlorhydria leading to hypergastrinaemia.

Achlorhydria↗
PubMed1986

Relations between circulating gastrin and endocrine cell proliferation in the atrophic gastric fundic mucosa.

It has been suggested that gastrin may be a causative factor in the proliferation of gastric fundic mucosal endocrine cells, as seen in the Zollinger-Ellison syndrome and in atrophic gastritis with hypergastrinemia of antral origin. In the present study, morphometrically determined densities of endocrine cells in fundic mucosal biopsy specimens were related to basal levels of serum gastrin in 10 normal controls and 60 patients with achlorhydric fundic atrophic gastritis, of which 45 had pernicious anemia (5 with fundic mucosal carcinoid) and 15 had atrophic gastritis without pernicious anemia. The densities of fundic mucosal endocrine cells were positively related to the levels of serum gastrin (atrophic gastritis, rs = 0.65; atrophic gastritis and normal controls, rs = 0.72). The highest levels of serum gastrin were found in patients with carcinoid tumors (mean, 1659.3 pmol/l), followed by those in patients with focal hyperplasias (cluster formation) of endocrine cells (mean, 503.2 pmol/l) and those in patients without focal hyperplasias (mean, 304.4 pmol/l) (p = 0.03 and p = 0.04, respectively).

Adult↗
PubMed1986

Acid secretory tests in peptic ulcer disease before and after parietal cell vagotomy.

The aim of the present study was to evaluate the role of gastric acid secretory tests in predicting ulcer recurrence in a consecutive series of patients before and up to 5 years after parietal cell vagotomy (PCV). Included in the study are 405 patients with prepyloric or duodenal ulcer disease (57 recurrences). There were no differences in acid secretion in the group of patients with pyloric or prepyloric ulcer disease, with or without recurrences. Thus pre- and post-operative acid secretory tests are of no value in predicting the outcome of PCV in this group of patients. In the duodenal ulcer group both postoperative basal acid output and peak acid output after pentagastrin and after insulin were higher in patients with recurrences. The two best discriminatory values were the ratio between the preoperative and the 6-week value of basal acid output and the 6-week value of peak acid output after insulin. The results of the study suggests that the ratio of the basal output before surgery and 6 weeks after surgery is enough for judging the acid reduction after PCV and that only in the case of a recurrence should an acid stimulation test be used.

Duodenal Ulcer↗
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

Gastric endocrine cell hyperplasia and carcinoid tumors in pernicious anemia.

Endoscopic screening in 123 patients with pernicious anemia (PA) yielded 4 patients with solitary and 1 patient with multiple gastric carcinoid tumors. Quantitative histologic studies of multiple standardized biopsy specimens showed a significantly increased number of fundic mucosal argyrophil endocrine cells in 40 patients with PA when compared with 15 patients with simple fundic atrophic gastritis (p = 0.002) or 8 normal controls (p = 0.0001). Patients with simple atrophic gastritis had increased numbers of fundic mucosal argyrophil cells as compared with normal controls (p = 0.02). A significant difference was also noticed in the number of antral mucosal argyrophil cells between patients with PA and normal controls (p = 0.01), but not between patients with PA and patients with simple atrophic gastritis. It is concluded that, in addition to having hyperplasia of gastric mucosal argyrophil endocrine cells, patients with PA run an increased risk of developing gastric argyrophil cell carcinoid tumors, which should be regarded as potentially malignant.

Adenocarcinoma↗
PubMed1985

Ulcer healing and relapse prevention by ranitidine in peptic ulcer disease.

Ranitidine, 300 mg daily, was given to 92 patients with duodenal ulcer (DU), 38 with prepyloric ulcer (PPU), and 21 with gastric corporeal ulcer (GCU). The healing rates at 4 weeks differed for the different types of ulcers (P less than 0.01), being 91% for DU, 68% for PPU, and 81% for GCU. After established ulcer healing, maintenance treatment with either ranitidine, 100 mg twice daily or 150 mg at night, or placebo was given for 1 year or until ulcer relapse in a total of 108 patients--71 with DU, 24 with PPU, and 13 with GCU. There were no significant differences in relapse rates between the two groups treated with active drug or between the three ulcer groups. However, the overall relapse rate in the active drug groups was 16%, against 72% in the placebo group (P less than 0.001).

Antacids↗
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↗
PubMed1984

Prevalence and incidence of pernicious anemia. An evaluation for gastric screening.

To evaluate the feasibility of gastroscopic screening for gastric malignancy in patients with pernicious anemia, all individuals treated with vitamin B12 in a well-defined population were identified. Individuals treated for an uncertain diagnosis were submitted to supplementary examinations. Of all individuals treated with vitamin B12 41% had unequivocal pernicious anemia, 13% possible pernicious anemia, 26% vitamin B12 malabsorption other than pernicious anemia, and 20% no verified vitamin B12 deficiency. The maximum crude prevalence of pernicious anemia was 1.98 per mile and the crude maximum incidence 16.7 x 10(-5) x year-1. The estimated annual cost of endoscopic gastric screening at 3-year intervals in patients with pernicious anemia younger than 75 years of age would be SEK 15,000/100,000 inhabitants, a cost that to a great extent could be financed by a more adequate prescription of vitamin B12 treatment.

Adult↗
PubMed1983

Ulcer surgery made less expensive. A cost-development study: 1963, 1973, and 1978.

The cost for operative treatment of duodenal ulcer disease over a 15-year period was studied by carefully measuring on a day-to-day basis each cost item separately for every individual. All prices were transformed into 1975 cost level. Statistical analysis revealed a 42% reduction in the cost for operative treatment. This decrement in cost coincided with a change from partial gastrectomy to highly selective vagotomy as the routine procedure. Further refinement of highly selective vagotomy did not result in a further cost decrement.

Adult↗
PubMed1983

Pleural effusion with dyspnea as the presenting symptom in chronic pancreatitis. A case report.

A middle-aged male presented with progressive dyspnea and massive, leftsided pleural effusion. No intrathoracic cause was found, but a very high amylase activity induced suspicion of pancreatic disease. ERCP showed marked changes consistent with chronic pancreatitis in the distal pancreas. The patient recovered completely after prolonged pleural drainage and later resection of the pancreatic tail. A short review on the pertinent literature is given.

Chronic Disease↗