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Biomedical subjects

H Ekberg

Publications and source records attributed to H Ekberg.

At least 91 records · Page 5Linked to original sources
PubMed1991

The Allen Brown shunt: a useful option for vascular access.

This study analyzes the performance of 273 Allen Brown arteriovenous shunts inserted in the thigh and anastomosed to the superficial femoral artery and either the superficial femoral vein or the long saphenous vein. The median duration of shunt function was 9 weeks (range: 0 to 175 weeks). A significantly longer median function time of 22 weeks was found in patients who had had more than five previous access procedures (p less than 0.02). No other independent variable affecting shunt function time was identified. There were 84 complications (56 due to infection) and 2 deaths in the series. The infection rate was not improved by the use of perioperative antibiotics, with most infections occurring more than 6 weeks after insertion. Since the complication rate for Allen Brown shunts was no greater than that reported for subclavian catheters, and their function no less reliable than that reported for Quinton-Scribner shunts, the Allen Brown shunt is a useful option for short- and medium-term vascular access. It may also be useful for longer-term access in the patient in whom failure of multiple previous access procedures has occurred.

Adolescent↗
PubMed1991

Longitudinal histopathologic assessment of rejection after bladder-drained canine pancreas allograft transplantation.

In preparation for assessment of percutaneous biopsies in our clinical pancreas transplant program, a working knowledge of the histopathologic changes after transplantation was obtained in a longitudinal open biopsy study of 16 dogs receiving bladder-drained whole pancreas allografts. Edema, extravasation of polymorphs, and lymphocytes associated with focal parenchymal injury were early, invariable, and probably nonspecific findings. The initial feature of unmodified rejection was the appearance of capillary and small vein endothelial changes with mainly perivascular inflammatory cell infiltration. Acinar cell loss occurred early and was progressive, whereas islets and ducts were relatively preserved, indicating that acinar tissue may be more vulnerable to lytic necrosis when damaged. Functional rejection, determined by fasting urinary amylase levels, was at a stage of extensive and irreversible necrosis. Functioning grafts in immunosuppressed dogs had minor and transient endothelial changes with absence of class II antigen staining of parenchymal cells.

Acute Disease↗
PubMed1990

Repeated dearterialization of hepatic tumors with an implantable occluder.

A new implantable device for repeated hepatic dearterialization was evaluated in 13 patients with tumors of the liver. Eleven patients had colorectal secondaries and also received cyclic intraperitoneal infusion of 5-fluorouracil. Two patients had primary hepatocellular cancer (HCC). Four patients had a variant arterial supply. The hepatic artery was occluded repeatedly for 1 hour twice daily for 1 to 17 months (mean, 8.5 months). A complete transient occlusion was obtained in all but three patients, in whom minor collaterals were missed at the initial operation. Collaterals developed in two patients during therapy. Leakage from the balloon occurred in two patients after 5 and 12 months. Two patients developed thrombosis of the hepatic artery during therapy due to the cuff being placed too tightly around the vessel. A complete remission was demonstrated in one patient with HCC, a partial response in three patients (one HCC and two metastatic), stable disease in two patients, and progression in five patients. Median survival for colorectal lesions was 15 months (range, 2 to 23 months) from start of the occlusions. Four of nine patients developed calcifications of their lesions during therapy. One patient with HCC was alive and free of disease 18 months after the start of the occlusions. Both patients with HCC had an obstructed portal vein which may have contributed to the favorable outcome. The occluder was uniformly accepted by the patients who were able to do their occlusions at home.

Adult↗
PubMed1990

The accuracy of computed tomography of the liver in colo-rectal carcinoma.

A prospective study in 71 patients with colo-rectal carcinoma was undertaken to evaluate the accuracy of computed tomography (CT) of the liver and arterially enhanced liver CT (CTA). The results were initially based on the findings at surgery. The accuracy of CT was 82% and CTA 84%. Since the evaluation of the liver at surgery is not always correct, a clinical follow-up and repeat CT in the same group of patients was performed. The intention was to search for occult metastatic disease of the liver and thus more accurately evaluate the results of CT, CTA and the surgical evaluation at laparotomy. Both the presence or absence of tumour, as well as the distribution of tumour growth in the liver were considered. In comparison with the results of the follow-up, CT detected the presence and correctly described the tumour distribution in 86%, CTA in 87%, and the surgeon in 88% of the cases, respectively. CTA is recommended if the CT scan is negative or if a more detailed evaluation is required prior to liver resection.

Aged↗
PubMed1990

Canine pancreas and kidney transplantation following total-lymphoid irradiation.

The effect of total-lymphoid irradiation on survival of canine pancreas and kidney allografts was studied. TLI had a marked immunosuppressive effect as measured by in vitro immune responses and reduced circulating leukocytes. Despite the changes, median graft survival times for animals treated with 800 cGy (9 days) or 1800 cGy (9.5 days) were not significantly different from untreated control animals (7 days). The addition of low-dose antithymocyte globulin (10 mg/kg/day) on post-transplant days 0, 2, 4, 6, 8, and 10 had no measurable synergistic effect. Similarly, median segmental pancreas allograft survival times after 1700-2200 cGy of TLI treatment (16.5 days) were only marginally longer than those of untreated controls (9 days). The only animal to maintain a graft for greater than 200 days was matched to the donor in mixed lymphocyte culture (MLC). This animal was able to reject a third-party skin graft after 8 days while a graft from the original donor was still surviving after 21 days when the pancreas graft failed from a chronic-type rejection. These results indicate that TLI alone or in combination with ATG will not be predictably effective as a method of prolonging allograft survival. The role of matching major histocompatibility complex antigens in TLI treatment requires clarification.

Animals↗
PubMed1989

Percutaneous fine needle aspiration biopsy of canine pancreas allograft provides diagnosis of treatable rejection.

Despite improved pancreas transplant graft survival, early diagnosis of rejection remains a clinical challenge. Using a canine model of whole pancreas transplantation with bladder exocrine drainage we have shown fine needle aspiration biopsy (FNAB) to provide an earlier diagnosis of rejection than fall in urinary amylase (UA). The aim of this study was to assess the ability of anti-rejection therapy to reverse rejection when the diagnosis was based on either FNAB findings or a fall of UA. Sixteen dogs received a total pancreas allograft with an inadequate dose of oral cyclosporine (5 mg/kg/day). Fasting UA levels were measured daily and percutaneous FNAB with ultrasound guidance was performed three times weekly on all dogs. The diagnosis of rejection was made in alternate dogs with either a fall of UA to a level of less than 5000 IU/liter (median 7 days) or when the total corrected increment (TCI) of aspirated infiltrating cells was greater than 2.6 (median 5 days). Anti-rejection therapy consisted of methylprednisolone 10 mg/kg/day iv for 5 days and an increase of oral cyclosporine dosage to 25 mg/kg/day. Early vascular thrombosis (Day 2) occurred in three allografts. Diagnosis of rejection based on a low level of UA permitted the successful reversal of rejection in only one of six grafts, whereas five of seven grafts were successfully treated when rejection diagnosis was based on FNAB. Median allograft survivals were 9 days (range 8-19) and 32 days (range 11-63), respectively (P less than 0.01). The earlier diagnosis of allograft rejection made by FNAB improved the ability of conventional anti-rejection therapy to reverse pancreas allograft rejection and significantly improved allograft survival.

Amylases↗
PubMed1989

Canine whole pancreatic transplantation with exocrine drainage into the bladder.

A canine model of whole pancreas transplantation with pancreaticocystostomy was studied for reproducibility and long-term graft function with oral cyclosporine. The feasibility of the operative technique was established in three dogs and the graft histology at 5 days was studied. Seven pancreatectomized dogs were transplanted without immunosuppression; acute rejection was evident at a median of 10 days (range: 7-12 days). Another 14 non-pancreatectomized dogs were given oral cyclosporine (25 mg/kg per day) resulting in prolonged graft survival (P less than 0.01) with a median (actuarial) survival of 91 days (range: 8-159 days); five dogs had vascular thrombosis or graft rejection and eight dogs died with functioning grafts. Early technical loss in two dogs (8.3%) was due to arterial thrombosis. It is concluded that the model of whole pancreas transplantation was reproducible in dogs, that long-term graft function can be achieved on oral cyclosporine, and that duct patency can be maintained. Graft infarction, either primary or due to rejection, continues to complicate this model of pancreas transplantation.

Animals↗
PubMed1989

Improvement of canine pancreas-allograft survival with diagnosis of rejection by fine-needle aspiration biopsy.

Early diagnosis of rejection in pancreas-allograft transplantation remains a clinical challenge. The aim of this study was to assess the ability of antirejection therapy to reverse rejection when the diagnosis was based on either fine-needle aspiration biopsy (FNAB) or urinary amylase (UA). Sixteen dogs received a total-pancreas allograft with exocrine drainage into the bladder. Initially, a deliberately low dose of cyclosporin was given. Monitoring included percutaneous FNAB with ultrasound guidance and fasting spot measurements of UA. The diagnosis of rejection was made in alternate dogs when UA fell to less than 5000 IU/L (group A) or when the total corrected increment (TCI) of aspirated infiltrating cells was greater than 2.6 (group B). Antirejection therapy consisted of 10 mg.kg-1.day-1 i.v. methylprednisolone for 5 days and an increased dose of cyclosporin (25 mg.kg-1.day-1). The median allograft survival was 9 days (range 8-19) in group A and 32 days (range 10-63) in group B (P = .01). A fall in UA permitted the successful reversal of rejection in only one of six grafts, whereas five of seven grafts were successfully treated when rejection diagnosis was based on FNAB. In conclusion, early diagnosis of rejection was achieved by FNAB, improving the ability of antirejection therapy to reverse pancreas-allograft rejection and prolong survival.

Animals↗
PubMed1989

Estrogen receptor immunocytochemical assay on cytologic material from primary and metastatic breast cancer.

The determination of estrogen receptor (ER) status in primary and metastatic breast tumours has been facilitated by the recent advent of monoclonal antibodies to ER. The aim of this study was to determine the feasibility of estrogen receptor immunocytochemical assay (ER-ICA) applied to cytologic specimens from primary and metastatic breast tumours. One hundred and sixty specimens from 133 patients were evaluated by cytologic ER-ICA. Comparison with histologic ER-ICA was available for 28 of the specimens and with cytosol assay for 27 specimens. Some 101 of the 160 samples were breast lesions of which 87 had a definitive diagnosis of breast carcinoma. Of these, 68% were considered positive for ER. Metastatic breast cancers comprised 59 of the 160 specimens of which 37% were found to be positive for ER. The predominant staining intensity (SI) of the nuclei of the tumour cells added to the percentage of cells (PC) stained gave an estrogen receptor score (ERS) in both cytologic and histologic specimens. A positive threshold was determined for an ERS greater than 2, equivalent to ER levels greater than 10 fmol/mg of protein. We observed very good correlation between cytologic ERS and the corresponding cytosol assay values (r = 0.74; p less than 0.001; n = 27). The sensitivity was 95% and the specificity 88%. Correlation with histologic ER-ICA was also very high (r = 0.83; p less than 0.001; n = 28). We assessed the role of video image analysis (VIA) and did not find any additional advantages in evaluating cytologic ER-ICA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenofibroma↗
PubMed1988

Intraperitoneal infusion of 5-FU in liver metastases from colorectal cancer.

Intraperitoneal 5-fluorouracil (5-FU) was given to eight patients with unresectable colorectal liver cancer and to one patient after radical hepatectomy. A subcutaneous intraperitoneal access device was implanted, and treatment consisted of continuous infusion of 1,000 mg 5-FU/d for 5 days, repeated every 6 weeks. Evaluation of treatment was performed after every two cycles of therapy. A total of 32 infusion cycles were given. The mean steady-state concentration of 5-FU was 0.56 +/- 0.04 mumol/l (mean +/- SEM), and the total body clearance was 10.0 +/- 0.71/min mean +/- SEM). The levels of 5-FU in peripheral venous blood were stable and reproducible. When incubated in whole blood at 37 degrees C the concentration of 5-FU fell rapidly and after 2 h, only 22% of the starting level remained. When kept ice-cold, 5-FU samples were stable. Patient acceptance was excellent, and the therapy was free from complications except for slight abdominal discomfort, not enough to require alleviation by analgesic drugs. Computerized tomography (CT) scan showed stationary tumor volume after two cycles of therapy in four of eight patients who could be evaluated. It is concluded that continuous intraperitoneal infusion of 5-FU produces stable and reproducible levels of the drug in peripheral venous blood, that 5-FU is degraded by blood cells at 37 degrees C, that the use of a subcutaneous access device makes the delivery easy and safe, and that the efficacy of the therapy seems to be similar to that obtained with hepatic arterial infusion.

Abdomen↗