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Biomedical subjects

G Olaison

Publications and source records attributed to G Olaison.

At least 55 records · Page 3Linked to original sources
PubMed1993

Intraoperative enteroscopy in Crohn's disease.

Intraoperative small bowel endoscopy was performed on 33 occasions in 31 patients with Crohn's disease. The extent of mucosal inflammation was compared with that of changes in the external bowel wall: serositis, fat-wrapping and mural thickening. The influence of endoscopic findings on surgical management was evaluated. Mucosal inflammation was generally more extensive than serositis (P < 0.01), but less so than mural thickening (P < 0.001). The extent of fat-wrapping did not differ from that of mucositis. Of 23 patients undergoing reoperation or with fistula or abscess, however, eight had serositis and/or fat-wrapping in bowel segments without mucosal inflammation. Endoscopic findings influenced surgical decisions on 20 of the 33 occasions, limiting planned resection in 14, identifying strictures for repair in one, and deciding against resection in two cases and for extended resection in three. These results suggest that external inflammatory changes are unreliable guides to the extent of intestinal mucositis and requirements for resection in Crohn's disease. By visualizing the mucosa, intraoperative enteroscopy can provide information for more precise surgery, thereby limiting resection.

Adolescent↗
PubMed1993

Increased absorption of polyethylene glycol 600 deposited in the colon in active ulcerative colitis.

A defect in the barrier function of the intestinal mucosa has been proposed as important in both the pathogenesis and systemic manifestations of inflammatory bowel disease. After colonoscopy, polymers of polyethylene glycol (PEG) with molecular weights of 414-810 (mean 600), were instilled in the descending colon of patients with ulcerative colitis (n = 17) and in controls without intestinal inflammation (n = 8). The patients with active ulcerative colitis (n = 6) had a significantly increased uptake of PEGs in the molecular weight range 458-810, measured as urinary excretion over the first 6 hours after instillation. The median values for their excretion were 2.85-3.80% of PEGs instilled compared with 0.32-0.94% for patients in remission (n = 11) (p < 0.05-0.01) and 0.17-0.60% for the controls (p < 0.05-0.01). The differences in absorption of PEG 414 did not reach the present level of statistical significance. There was a positive correlation between PEG absorption and the endoscopic and histological grading of inflammatory activity in the sigmoid colon (p < 0.01-0.001). These findings support a correlation between the presence of active inflammation and PEG absorption. There was little evidence to support the presence of a primary defect in the colonic barrier in patients with ulcerative colitis.

Adolescent↗
PubMed1993

Smoking and intestinal absorption of oral polyethylene glycols in Crohn's disease.

Intestinal absorption of orally administered polyethylene glycols with molecular weights of 634-1250 was investigated in 55 patients with Crohn's disease and in 20 healthy controls and was related to smoking habits at the time of testing. In the Crohn patients the polyethylene glycol absorption was also related to smoking habits at the time of diagnosis. Absorption of polyethylene glycols was impaired in Crohn patients compared with controls, but within both groups no difference was found among smokers, ex-smokers, and never-smokers (p > 0.05). Among the Crohn patients, those who smoked at the time of diagnosis had less impaired absorption (p < 0.02) of the smaller polyethylene glycols (634-942 Da) than those who did not. These data do not support the concept of altered intestinal permeability as the mechanism by which smoking influences Crohn's disease.

Administration, Oral↗
PubMed1993

Femoral nerve neurilemmoma in the iliac fossa.

A rare case of femoral nerve neurilemmoma in the right iliac fossa, presenting as a firm tumour with local discomfort, is described. Modern imaging techniques could not differentiate the tumour. At explorative laparotomy the tumour was identified as a neurilemmoma of the femoral nerve and enucleated. The diagnosis should be borne in mind in cases of retroperitoneal tumours of unclear origin. Inappropriate surgery results in nerve damage and paralysis.

Adult↗
PubMed1992

Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms.

Forty two Crohn's disease patients were followed up after ileocolic resection with regard to symptoms and endoscopic appearance of the ileocolic anastomosis. Twenty eight patients resected because of colonic neoplasm served as controls. In all the Crohn's disease patients the ileal resection margin was disease free macroscopically at operation. In addition, intraoperative ileoscopy was performed in 13 and no sign of residual inflammation in the neoterminal ileum was seen. Endoscopy soon after surgery often showed preanastomotic ileal ulceration before symptoms appeared, whereas no anastomotic lesions were observed in the controls. Thus, 22 of 30 Crohn's disease patients examined had ulceration of the anastomotic area after three months, but only 10 had developed symptoms indicating relapse (73 v 33%). Corresponding figures in the 30 patients examined after one year were 93 v 37%, and in 14 patients after three years they were 100 and 86% respectively. The inflammatory lesions in all cases were preanastomotic, in the neoterminal ileum, and showed time related progression from aphthae to larger ulcers and stricture. The study suggests that endoscopically observed inflammatory lesions that appear soon after ileocolic resection for Crohn's disease signify new inflammation and not residual, persistent disease or incomplete anastomotic healing. The data further suggest that despite clinical remission after apparently radical intestinal resection, the bowel is permanently inflamed in Crohn's disease.

Adolescent↗
PubMed1992

Initiation of anastomotic recurrence of Crohn's disease after ileocolic resection. Onset proximal to the junction and preceded by increased phospholipase A2 activity.

Colono-ileoscopy was performed on 11 patients after ileocolic resection for Crohn's disease, to observe development of recurrent anastomotic inflammation and its relationship to mucosal phospholipase A2 (EC 3.1.1.4) activity. Ileal inflammation appeared soon after surgery in eight cases but in none of nine controls with noninflammatory bowel disease. The ileal inflammation was more severe 1-3 cm above than greater than 5 cm above the ileocolic junction (p less than 0.05), whereas the postanastomotic colonic mucosa remained unchanged. Ileal phospholipase A2 activity in the mucosa was equally raised at the two ileal sites (p less than 0.01 and less than 0.02), irrespective of the presence or absence of inflammation. In colonic postanastomotic mucosa the phospholipase A2 activity was the same as in the controls. Further followup showed preanastomotic ileal inflammation at both investigated levels in all patients with Crohn's disease but still with greater severity close to the mucosal junction (p less than 0.05). The study indicates that recurrent inflammation in Crohn's disease is initiated in the terminal ileum close to the ileocolic junction. Progression of severity is accompanied by greater proximal involvement. The increase in mucosal phospholipase A2 activity, which precedes endoscopically detectable inflammation, implies a role for this enzyme in Crohn's disease.

Adult↗
PubMed1991

Phospholipase A2 activity of colonic mucosa in patients with ulcerative colitis.

Activation of enzyme phospholipase A2 (EC 3.1.1.4), the major liberator of arachidonic acid, has been proposed as a component in the pathogenesis of inflammatory bowel disease. To test the hypothesis that phospholipase A2 activity is increased in ulcerative colitis, enzyme activity was investigated in colonic biopsies using radiolabelled Escherichia coli as substrate. The study comprised patients with ulcerative colitis (n = 19) and controls without inflammatory bowel disease (n = 7). Ulcerative colitis patients were grouped into those with active disease (n = 8) and those in remission (n = 11) at the time of colonoscopy. No differences were found in mucosal phospholipase A2 activity between patients with active disease, patients in remission and controls. With the present assay we were unable to demonstrate activation of phospholipase A2 as a mechanism in the inflammatory process of ulcerative colitis.

Adult↗
PubMed1990

Surgical treatment of dorsocaudal dislocation of the vagina after excision of the rectum. The Kylberg operation.

Retained menstrual blood, colpitis, chronic discharge from the vagina, and dyspareunia are not uncommon symptoms after proctectomy. In patients suffering from this syndrome, the vaginal drainage is impaired because of a pouch caused by adhesions formed between the coccyx and the vagina, and an angulation of the upper part of the vagina. Surgical treatment consists of extirpation of the coccyx, separation of the posterior fornix from the lower part of the sacrum, and interposition of muscle flaps from the right and left gluteus maximus muscle, which shifts the vagina to a more vertical position. The authors report the results of this procedure in nine women observed for more than two years. Wound infection occurred in two patients, and one underwent a second operation because of relapsing symptoms. Eight patients were relieved of impaired drainage of the vagina; one patients empties her menstrual blood by straining. Dyspareunia disappeared in all patients. The operation can be recommended in patients with "the horizontal vagina syndrome."

Adult↗
PubMed1990

Ileocolic nipple valve anastomosis for preventing recurrence of surgically treated Crohn's disease. Long-term follow-up of six patients.

To prevent coloileal reflux after ileocecal resection, an ileocolic nipple valve anastomosis was constructed in six patients with Crohn's disease. The patients were observed for more than 7 years and were compared with 21 Crohn patients in whom conventional end-to-end ileocolic anastomosis was performed during the same period. The outcome was more favorable in the group with nipple valve anastomosis, i.e., longer interval between surgery and symptomatic relapse, and tendency to less frequent recurrence and re-resection. An association was found between radiologically preserved nipple valve and remission, and two patients with intact valve at long-term follow-up remained symptom-free. The observations implied that protection of the terminal ileum from coloileal reflux after ileocecal resection for Crohn's disease may favorably influence the prognosis.

Adolescent↗
PubMed1990

Glucocorticoid treatment in ileal Crohn's disease: relief of symptoms but not of endoscopically viewed inflammation.

The effect of prednisolone (20-30 mg daily for six to nine weeks) was studied in eight patients with Crohn's disease and recurrent, preanastomotic ileal inflammation, in respect of symptoms, endoscopic findings and phospholipase A2 activity in the ileal mucosa. The Harvey-Bradshaw Crohn's disease activity index improved significantly, mainly because of reduced frequency of loose stools and diminution of abdominal pain. Endoscopy revealed no corresponding decrease in ileal inflammation, which in all cases persisted after treatment. The phospholipase A2 activity in the ileal mucosa was not altered by prednisolone. In two of three patients with concomitant colitis colonic inflammation improved. The study confirmed earlier reports of good symptomatic relief from glucocorticoid treatment in Crohn's disease of the small bowel, but endoscopy suggests that this improvement was not the result of resolution of small intestinal mucosal inflammation.

Adult↗
PubMed1990

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Acute Disease↗
PubMed1990

Novel aspect of Crohn's disease: increased content of platelet-activating factor in ileal and colonic mucosa.

Intestinal mucosal content of platelet-activating factor (PAF-acether) was investigated in Crohn's disease. The PAF-acether content was determined in mucosal biopsies from the ileum and colon in Crohn patients (n = 13), and in normal mucosa of control patients (n = 11). PAF-acether was found in both groups and was raised in Crohn patients, both in the ileum (6.3 +/- 4.7 vs. 0.6 +/- 0.4 pmol/g; p less than 0.01) and colon (6.2 +/- 4.2 vs. 0.7 +/- 0.4 pmol/g; p less than 0.01). Colonic PAF-acether content was raised irrespective of the presence of colonic inflammation as judged macroscopically. These findings add further support to the importance of bioactive lipids in inflammatory bowel disease and suggest a possible role for PAF-acether in Crohn's disease.

Adolescent↗
PubMed1990

Complications, surgical revision and quality of life with conventional and continent ileostomy.

Continent ileostomy remains an alternative to restorative proctocolectomy in selected cases. Results with continent ileostomy in 55 patients are reported--in 82% after conversion from conventional ileostomy. Three years postoperatively 93% were continent and 7% partially continent, and after 5 years 95% were continent. Complications requiring laparotomy arose in ten patients (18%) during the immediate postoperative period (30% among the first 27 patients, 7% of the subsequent 28). The incidence of late complications requiring laparotomy was 16% in the first year, 10% in the next 2 years and 5% after the third year. Slipping of the nipple occurred in 9% of the patients in the first postoperative year. No reservoir has been removed. The quality of life improved after colectomy with conventional ileostomy, but most patients experienced a dramatic further improvement after construction of the continent ileostomy. The improvement in ultimate quality of life was not influenced by revision for malfunction of continent ileostomy.

Adolescent↗
PubMed1989

Increase in permeability and phospholipase A2 activity of colonic mucosa in Crohn's colitis.

Patients with Crohn's colitis were investigated regarding the relationship between intestinal inflammation, mucosal activity of phospholipase A2 and intestinal permeability to different-sized polyethylene glycols (PEG). Mucosal specimens for phospholipase A2 were obtained at colonoscopy and PEG (590-942 daltons) were deposited in the descending colon. Colonic absorption was measured as urinary output of deposited PEG. Colonic absorption of PEG was higher in these patients, even when the colitis was in remission at colonoscopy, than in ileal Crohn's disease or control patients. Mucosal phospholipase A2 activity was increased in active colitis, but in the patients with endoscopic remission it was at the same level as in the controls or in the patients with ileal Crohn's disease. The observations suggest that increased intestinal permeability may be a primary factor in activation of mucosal phospholipase A2 activity and in intestinal inflammation.

Adolescent↗
PubMed1989

Abnormal intestinal permeability pattern in colonic Crohn's disease. Absorption of low molecular weight polyethylene glycols after oral or colonic load.

Intestinal permeability to different-sized polyethylene glycols in Crohn's disease of the colon was compared with that in ileal Crohn's disease and in controls without inflammatory bowel affection. The permeability was assessed both after ingestion of the marker (oral load) and after deposition in the colon during colonoscopy (colonic load). After oral load the absorption was least in the patients with colonic Crohn's disease, intermediate in ileal disease, and greatest in the controls. After colonic load, however, the values were highest in colonic Crohn's disease. The study indicated that in Crohn's disease of the colon there is abnormal permeability in apparently uninvolved proximal small intestine as well as in the colon. Since oral load tests preferentially reflect the absorptive properties of the proximal small bowel, regional tests of absorption are important when the aim is to assess the permeability of the distal small intestine or the colon.

Administration, Oral↗
PubMed1988

Intestinal permeability to polyethyleneglycol 600 in Crohn's disease. Peroperative determination in a defined segment of the small intestine.

Ileal permeability to different sized polyethyleneglycols (590-942 dalton PEG) was investigated peroperatively in 11 patients with Crohn's disease and seven with colonic carcinoma. A 15 cm ileal segment was converted into a tied loop, in which the PEG's were deposited. Absorption from the ileal segment was then measured as six-hour urinary recovery of the PEg dose. Polyethyleneglycol absorption in Crohn's disease was greater than in cancer patients and similar throughout the weight range, but in the cancer patients it was inversely proportional to molecular weight. Thus there was significantly greater absorption of the higher weights (greater than or equal to 678 dalton) in the Crohn's, than in the cancer patients. The apparently increased permeability of the small intestine in Crohn's disease may be an important factor in its pathogenesis.

Adolescent↗