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Biomedical subjects

G Mellbring

Publications and source records attributed to G Mellbring.

At least 19 recordsLinked to original sources
PubMed1994

Diagnosis of traumatic pancreatic duct rupture by on-table endoscopic retrograde pancreatography.

We report on two children who sustained blunt abdominal trauma with pancreatic duct rupture diagnosed by ERP (endoscopic retrograde pancreatography). Examinations were done with patients on the operating table anesthetized for laparotomy (on-table ERP). In both patients, duct laceration remained undiagnosed by computerized tomography and ultrasonography. Operative strategy depends on whether the pancreatic duct is lacerated or not. Findings during on-table ERP allow decisions on operative strategy in patients with pancreatic trauma.

Adolescent↗
PubMed1987

Gardner's syndrome with gastric and ileal polyposis. Case report.

A case of Gardner's syndrome with multiple colorectal carcinomas and polyposis of duodenum, ileum and stomach is reported. The patient was treated with colectomy, mucosal proctectomy and ileoanal anastomosis with ileal reservoir. The rationale of saving ileum and the anal function in presence of ileal adenomas and intramucosal rectal cancer is discussed.

Duodenal Neoplasms↗
PubMed1986

Venous thromboembolism after cerebral infarction and the prophylactic effect of dextran 40.

In a prospective study of the incidence of deep vein thrombosis (DVT) after stroke, and the prophylactic effect of dextran, 50 patients, admitted with a diagnosis of cerebral infarction with paresis of the lower extremity within the first 48 hours, were randomly allocated to treatment or non-treatment groups. The treatment group received 500 ml of dextran 40 on admission and on days 1 and 2, and 250 ml on days 4 and 6. Venesection was performed on admission and if necessary on day 1. The control group received no dextran or venesection. DVT was diagnosed with the 125I-fibrinogen test during the first ten days. The incidence of DVT was 54% in the treatment group and 50% in the control group. There were no statistically significant differences between the groups regarding number of DVTs needing treatment, number of positive scanning points or number of days for scan to become positive. Lethal pulmonary emboli occurred in one treated and in three control patients, respectively. Age and progress of neurologic symptoms predisposed for the development of DVT. The high incidence of DVT in stroke patients indicates the need for prophylactic routines.

Aged↗
PubMed1986

Relationship between factor XII, von Willebrand factor and postoperative deep vein thrombosis.

The development of postoperative deep vein thrombosis (DVT) was studied in 45 patients subjected to major abdominal surgery, 17 of whom showed signs of DVT as defined by 125I-fibrinogen test. The preoperative levels of von Willebrand factor (F VIII RAg) and platelets were higher in these 17 patients than in those remaining free from DVT. A contributing factor in DVT development thus may be more active primary haemostasis. Preoperative F XII levels were similar in the two groups, but the post-operative drop in F XII was more pronounced in the DVT group. An inhibitor of plasminogen activation behaved similarly in both groups. C1-inhibitor, the main inhibitor of the F XII-dependent clotting and fibrinolytic pathways, showed a typical acute-phase response postoperatively, without intergroup difference. The study suggested that F XII-dependent pathways play a role in the genesis of venous thrombi, at least in the postoperative period, though whether the postoperative F XII drop was due to a role in clotting or to fibrinolysis activation remains unclear.

Complement C1↗
PubMed1986

Age dependence of tissue plasminogen activator concentrations in plasma, as studied by an improved enzyme-linked immunosorbent assay.

A procedure for improving the specificity of enzyme-linked immunosorbent assays (ELISA) was devised, based on addition of antigen-specific or non-immune immunoglobulins to the citrated plasma sample and defining the difference in assay response between these two mixtures as the antigen-specific part of the response. When applied to measurement of tissue plasminogen activator (t-PA; EC 3.4.21.31) antigen in plasma, this procedure resulted in elimination of the overestimates obtained in a large proportion (10-20%) of patients' samples when assayed according to the conventional ELISA technique. Basal t-PA concentrations in plasma were found to be highly age-dependent, normal values being about 3 micrograms/L for adults near 30 years of age and about 10 micrograms/L for those over 60. Patients with gallbladder stone disease had increased mass concentrations of t-PA in plasma, even when corrected for the age effect; patients with multi-infarct dementia did not.

Adult↗
PubMed1986

Prophylaxis of deep vein thrombosis after major abdominal surgery. Comparison between dihydroergotamine-heparin and intermittent pneumatic calf compression and evaluation of added graduated static compression.

In a prospective, randomized study on 114 patients undergoing major abdominal surgery, the prophylactic effect of dihydroergotamine (DHE) combined with low-dose heparin (LDH) against postoperative deep vein thrombosis (DVT) was compared with that of peroperative intermittent pneumatic calf compression (IPCC). The additive effect of graduated pressure stockings was also studied, by randomizing a stocking to the right or left leg in each patient. The 125I-fibrinogen test was used to diagnose DVT. The incidence of postoperative DVT was significantly lower in the DHE-LDH than in the IPCC group (4% v. 19%). In the IPCC group the incidence of postoperative DVT was equal in legs with and without stocking. The study thus indicated that DHE-LDH is more effective than peroperative IPCC in preventing DVT after major abdominal surgery, and that graduated pressure stockings do not enhance the prophylactic effect of peroperative IPCC.

Abdomen↗
PubMed1986

An unusual case of postoperative incarcerated diaphragmatic hernia.

A very unusual case of incarcerated afferent loop in a postoperative diaphragmatic hernia after a Billroth II operation and a subsequent thoraco-abdominal resection of a benign oesophago-cardial stricture is presented. Insufficient closure of the diaphragm combined with long loops after a gastro-jejunostomy seemed to be the predisposing factor to this unusual postoperative complication. The risk of rare cases of incarcerated diaphragmatic hernia should be considered after proximal gastric resection.

Female↗
PubMed1985

Relationship between preoperative status of the fibrinolytic system and occurrence of deep vein thrombosis after major abdominal surgery.

This study comprised 50 patients subjected to major abdominal surgery, of which 13 developed deep vein thrombosis (DVT) according to the 125I-fibrinogen test. Plasma was sampled preoperatively, for the specific analysis of tissue plasminogen activator (t-PA) before and during venous occlusion. The recently described fast t-PA inhibitor and plasmin alpha 2-antiplasmin complex (PAP) were also measured. The result of the laboratory analyses were correlated to the development of DVT. From the data obtained it is concluded that the evaluation of t-PA release during venous occlusion is a poor predictive factor for the occurrence of DVT after major abdominal surgery. The level of the t-PA inhibitor appears to be raised in these patients, but the values obtained in this material were not related to the development of postoperative DVT. Patients with elevated PAP levels, as shown previously, have a lesser tendency to develop postoperative DVT.

Adult↗
PubMed1985

Prediction of deep vein thrombosis after extensive abdominal operations by the quotient between plasmin-alpha 2-antiplasmin complex and fibrinogen concentration in plasma.

In 97 patients over 49 years of age who underwent extensive abdominal operations, post-operative deep vein thrombosis was prospectively diagnosed by the 125I-fibrinogen test. Blood was sampled preoperatively for analysis of the plasma levels of PAP (by a radioimmunoassay) and fibrinogen. The development of postoperative deep vein thrombosis was correlated to the quotient between the preoperative plasma concentration of PAP and fibrinogen. The quotient was significantly lower in the 30 patients who had thrombosis develop postoperatively as compared with the patients who did not. A simple linear discrimination analysis showed that, in the 31 patients with a quotient of more than 0.48, only two patients (6 per cent) had deep vein thrombosis. The results emphasize the importance of the preoperative fibrinolytic status in the development of postoperative deep vein thrombosis. The results of the study indicate that the quotient between PAP and fibrinogen concentration in plasma might be used for the prediction of patients with a high risk for having deep vein thrombosis develop after undergoing extensive abdominal operations.

Adult↗
PubMed1985

Relationships between tissue plasminogen activator, steroid hormones and deep vein thrombosis.

The plasma concentrations of tissue plasminogen activator (t-PA) antigen, cortisol, testosterone, dehydroepiandrosterone sulphate, FSH and LH were studied in 33 men undergoing major abdominal surgery. Significant positive correlation was found between the concentrations of t-PA antigen and cortisol, suggesting that the adrenal cortex has a role in the regulation of extrinsic fibrinolysis. These two variables, however, did not distinguish between patients with postoperative deep vein thrombosis (diagnosed by 125I-fibrinogen uptake test) and those without this complication. Such distinction was possible, however, with another steroid hormone of the adrenal cortex, dehydroepiandrosterone sulphate. At present, no explanation in terms of haemostatic mechanisms can be offered for this finding.

Adrenal Cortex Hormones↗
PubMed1985

Plasma fibrinolytic activity in patients undergoing major abdominal surgery.

The fibrinolytic system was studied in 30 patients undergoing elective cholecystectomy and in 30 with more advanced elective abdominal surgery. Blood was sampled before, during and after operation for determination in plasma of the tissue plasminogen activator (t-PA), the recently described fast t-PA inhibitor, and plasmin alpha 2-antiplasmin complex (PAP). In addition the t-PA activity during venous occlusion was determined preoperatively. Most of the patients showed raised t-PA levels during surgery, but the interindividual variation was wide and was not correlated to fibrinolytic capacity measured preoperatively as enhancement of t-PA activity during venous occlusion. The levels of the t-PA inhibitor rose during and immediately after surgery, and were higher in patients without increased t-PA activity during surgery. The patients with more advanced disease had higher levels of the inhibitor than the cholecystectomy patients. The data suggest that the t-PA inhibitor may influence the fibrinolytic response to surgical trauma and may explain the previously reported shutdown in fibrinolysis in the early postoperative period. PAP, used as reflecting the overall fibrinolytic activity, was increased in plasma after the first postoperative days.

Adult↗
PubMed1984

Tissue plasminogen activator concentrations in major abdominal surgery. Relationship to postoperative deep vein thrombosis.

Tissue plasminogen activator (t-PA) antigen concentrations were studied in 47 patients subjected to major abdominal surgery. The 17 patients, which developed postoperative deep vein thrombosis (DVT), diagnosed with the 125I-fibrinogen uptake test, had higher levels preoperatively, and on the sixth postoperative day, when the thrombi had already formed. The reduced fibrinolytic activity in patients with a predisposition to postoperative deep vein thrombosis is thus not related to any t-PA deficiency. The postoperative fibrinolytic shutdown may however partly be due to a drop in t-PA antigen levels, at least in the patients, which developed DVT.

Abdomen↗
PubMed1984

In vivo metabolism of human tissue-type plasminogen activator.

The turnover of human tissue-type plasminogen activator (t-PA), purified from cell culture fluids and radiolabelled with 125I, was studied in 2 healthy males. After injection, the plasma radioactivity initially disappeared with a half-life of about 3 min, but after 30 min reached a plateau level which persisted for several hours. The radioactive material had then already been converted to forms soluble in 10% trichloroacetic acid (TCA). Surface counting rates indicated a rapid uptake in the liver during the first 10 min after injection, followed by a rapid release from the liver, beginning already at 25 min, which coincided with the appearance of the TCA-soluble radioactive material. After 18 h, about 80% of the injected dose had already been excreted in the urine. We conclude that, in humans, injected t-PA is rapidly cleared from the circulation, mainly by the liver, and within 30 min metabolized to low molecular weight forms which ultimately (within 1 d) appear in the urine.

Adult↗
PubMed1984

Snowmobiling injuries: types and consequences.

In a prospective study from northern Sweden, a series of 137 persons injured in snowmobiling accidents was analyzed. Most of the injured riders were males aged 10 to 39 years. Almost two-thirds of the accidents occurred at week-ends and the frequency was highest in the months of March and April. Three of four persons were injured during racing or leisure activities. The accidents most often involved sudden arrest of the snowmobile due to collision with an obstacle, or fall from the machine while driving it. The injuries were of major degree (MAIS greater than or equal to 2) in almost half of the cases and the lower extremities were the most commonly injured sites. In-patient care was required by 28% of the injured, for on average 11 days. Sickness insurance benefit was received by 64%, mean 48 days. The cost of treatment and sickness benefit averaged 8 000 SEK per case.

Accident Prevention↗
PubMed1983

Fibrinolytic activity in plasma and deep vein thrombosis after major abdominal surgery.

In a prospective study of the frequency of deep vein thrombosis (DVT) in 45 patients subjected to major abdominal surgery, 17 patients showed signs of DVT as assessed by the 125I-fibrinogen test. In 15 of the patients the DVT was diagnosed during the first four postoperative days. Blood samples were taken pre- and postoperatively and analysed for fibrinogen, prothrombin complex, APTT, platelet-count, plasminogen, alpha 2-antiplasmin, fibrin(ogen) degradation products, and plasmin-alpha 2-antiplasmin complex (PAP). The latter was used in order to reflect the fibrinolytic activity. Preoperatively, and postoperatively on day 3, the levels of PAP were significantly higher in patients without postoperative DVT. The data suggests that patients subjected to major abdominal surgery, who have enhanced fibrinolytic activity preoperatively, have a lesser tendency to develop postoperative DVT. Patients with postoperative DVT may have decreased fibrinolytic ability. From the data of the other parameters it is concluded that patients with DVT can have increased levels of FDP at the time of development of thrombosis.

Abdomen↗