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Biomedical subjects

H Graffner

Publications and source records attributed to H Graffner.

At least 37 records · Page 2Linked to original sources
PubMed1992

Does nicotine administration influence intragastric acidity?

Smokers have an increased incidence of duodenal ulcer with a high relapse rate whether they receive maintenance therapy with H2-receptor antagonists or not. They also tend to be slow healers. The etiology behind this is still unknown, and there is general disagreement as to whether smoking affects gastric secretion. In an earlier study we found a small but significant decrease in intragastric pH a short time after smoking a cigarette. The aim of the present investigation was to study whether intragastric pH changed during nicotine administration per se. Nicotine was given as a nasal spray to eight healthy smokers. Nicotine did not induce any acute detectable changes in gastric acidity when the 5-min period before spraying was compared with the 35-min period after spraying (median pH, 1.47 (25-75 percentiles, 1.40-2.32) and 1.55 (25-75 percentiles, 1.42-2.06), respectively). When different time periods during a day with hourly nicotine administration were analyzed, and the results compared with those of a similar day when placebo was given, nicotine was found to impair postprandial gastric neutralization. Median pH during the lunch hour was 1.93 (25-75 percentiles, 1.80-2.37) after nicotine and 2.86 (25-75 percentiles, 2.37-3.70) after placebo; p less than 0.025. Possible explanations for this might be nicotine-mediated effects on gastric motility or gastrin release.

Adult↗
PubMed1992

Fosfomycin/metronidazole compared with doxycycline/metronidazole for the prophylaxis of infection after elective colorectal surgery. A randomised double-blind multicentre trial in 517 patients.

OBJECTIVE: To find out if fosfomycin together with metronidazole was any better than doxycycline with metronidazole for the prophylaxis of infection before elective colorectal operations. DESIGN: Multicentre, double blind, random control trial. SETTING: Nine Swedish hospitals. SUBJECTS-559 patients admitted for elective colorectal operations. INTERVENTIONS: Fosfomycin 8 g and metronidazole 1 g before operation and fosfomycin 8 g eight hours afterwards, or doxycycline 400 mg and metronidazole 1 g before operation, and placebo eight hours afterwards. MAIN OUTCOME MEASURES: Incidence of all types of infection, mortality, and side effects. RESULTS: There were no significant differences between the groups for any of the outcome measures studied, the overall abdominal infection rates (wound, deep, and septicaemia) being 4.6% and 7.4%, and the remote infection rates (pneumonia, urinary tract, and central venous line) 15.1% and 12.8%, respectively. Of the predictors studied, only duration of operation was significantly related to risk of infection. CONCLUSION: The combination of fosfomycin and metronidazole was as safe and effective as that of doxycycline and metronidazole in preventing infections after elective colorectal operations.

Aged↗
PubMed1991

Estrogen receptors in the external anal sphincter.

Inasmuch as anal competence in women is reduced after the age of 50 years, it may be dependent on effects of estrogens. In this study, samples of the external anal sphincter were analyzed for the presence of estrogen receptors and were found to be present at a median concentration of 5.0 fmol per milligram of protein (range, 1.9 to 13) in women (n = 7), and 1.1 fmol per milligram of protein (range, 0 to 3.2) in men (n = 7). These findings are of interest with regard to the treatment of idiopathic anal incontinence.

Adult↗
PubMed1991

Helicobacter pylori, smoking and gastroduodenitis.

There is epidemiological evidence of an association between cigarette smoking and gastritis. To find out whether the reason for this might be related to the presence of Helicobacter pylori, biopsies were taken from the gastric corpus and antrum and from the duodenal bulb in 106 consecutive patients referred for oesophagogastroduodenoscopy because of epigastric pain. Patients with ulcer disease or cancer were excluded. The biopsy specimens were cultured for H. pylori and examined histologically for the presence and grade of gastritis and duodenitis. Thirty-five percent of the patients were H. pylori-positive and 57% had histological gastritis; 37% were cigarette smokers and among these, H. pylori was found significantly less frequently than in non-smokers (18 and 45%, respectively; 2p = 0.0083). Among patients colonized with H. pylori, gastritis was found in 89% compared to 39% in non-colonized patients (2p less than 0.0001). In spite of this, 51% of the smokers and 60% of the non-smokers (2p = 0.85) had histological gastritic mucosa. No differences in the severity of the gastritis or the duodenitis in patients with histologically positive findings could be seen when comparing smokers to non-smokers and H. pylori-positive to H. pylori-negative patients.

Causality↗
PubMed1991

Anaesthetic agents suppress basal and stimulated gastric acid secretion. Are intramural neurons involved?

Anaesthetized animals are often used in studies of gastric secretion. We have examined the effect of anaesthetics on the acid output in gastric fistula rats and pylorus-ligated rats, both vagally intact and denervated. Diethyl ether, chloral hydrate, and mebumal effectively reduced both basal and stimulated acid output in fistula rats. The acid output in pylorus-ligated rats was greatly reduced by the anaesthetics. In vagally denervated rats local nervous reflexes are thought to play an important role in the acid secretory response to pylorus ligation. Anaesthetic drugs suppressed acid output in both vagally intact and vagally denervated rats. The possibility of an action on intramural neurons cannot be excluded. The neuro-suppressive effect of anaesthesia should be considered in studies of gastric acid secretion.

Anesthetics↗
PubMed1990

Intrarectal ultrasonography in rectal cancer staging and in the evaluation of pelvic disease. Clinical uses of intrarectal ultrasound.

Accurate preoperative staging of a rectal cancer patient may impact heavily on subsequent management. This study attempts to evaluate the accuracy of intrarectal ultrasonography (IRUS) in staging rectal cancers compared to clinical and pathologic examination. In addition the accuracy of IRUS was assessed in a group of patients with uncertain pelvic-perirectal disease after a negative physical examination. In a prospective manner, 52 cancer patients were staged with digital exam and IRUS. Accuracy rates were 48% and 83%, respectively, compared to pathologic evaluation in assessing wall penetration, and IRUS identified positive lymph nodes in 12 of 17 cases. In patients with pelvic disease, IRUS corresponded with pathologic diagnosis in 15 of 17 cases and revealed new information in 6 patients. Intrarectal ultrasonography appears to be the most accurate imaging technique for staging rectal cancers and demonstrates promise in the evaluation of perirectal-pelvic disease.

Abscess↗
PubMed1987

One hundred patients ten years after parietal cell vagotomy.

One hundred patients with duodenal or pyloric/prepyloric ulcer disease were operated with parietal cell vagotomy (PCV) and followed for a minimum of 10 years. At 6 weeks, 1,5 and 10 years postoperatively gastric secretory tests, haematological work-up and clinical examination or telephone interview were performed. There was no operative mortality and the frequency of postoperative sequelae was minimal. The cumulative ulcer recurrence rate was 18 per cent and another 14 per cent had slight to moderate symptoms of epigastric pain without any signs of ulcer. Upper gastrointestinal endoscopy was used to reveal recurrences but was performed only if the patient had symptoms of recurrence. A rise in basal acid secretion and in pentagastrin-stimulated secretion was observed the first year postoperatively, whereas insulin-stimulated peak acid output increased during the first 5 years. We conclude that PCV has a low rate of per- and postoperative complications and an acceptable recurrence rate. Therefore, it seems that PCV is the method of choice in chronic duodenal ulcer disease.

Adult↗
PubMed1987

Effects of physiological increases of plasma noradrenaline on gastric acid secretion and gastrointestinal hormones.

It is not known if the increased plasma concentration of noradrenaline in patients with chronic duodenal ulcer disease is a pathogenetic factor or not. The aim of the present study was to investigate if physiologic changes of noradrenaline would evoke any alterations in gastric acid secretion or in the plasma concentration of some gastrointestinal hormones (gastrin, secretin, PP, PYY, and GIP) known to affect gastric physiology. The results show that basal plasma noradrenaline concentration was 1.8 nM and after infusion with noradrenaline at 0.04 or 0.2 nmol/kg/min plasma levels of 2.5 and 4.4 nM were obtained. No appreciable changes could be found in basal or pentagastrin stimulated acid secretion or in any of the gastrointestinal peptides studied. If the elevated plasma noradrenaline concentration observed in duodenal ulcer patients is a pathogenetic factor; it is probable that it interferes with other variables such as blood flow, bicarbonate secretion, or prostaglandin synthesis.

Adult↗
PubMed1986

Patient's and doctor's delay in carcinoma of the colon and rectum.

Despite sophisticated diagnostic equipment and modern surgical therapy, the prognosis for patients with colorectal carcinoma has not improved during the last few decades. One of the factors, possibly contributing to the prognosis, is the time between the patient's visit to the doctor and the final therapy. In order to estimate patients' and doctors' delay and to investigate the factors which may influence the time of delay, a prospective study was designed including 50 patients with carcinoma of the rectum or the sigmoid colon and 50 patients with colonic carcinoma above this level. All patients were interviewed by a doctor using a standard questionnaire, and initial symptoms, duration of symptoms, and type of clinical examination leading to diagnosis were recorded. The results show that 16% of the patients in the recto/sigmoid group suffered from patient's delay as opposed to 20% in the group of patients with carcinoma above 25 cm from the anal verge. Doctor's delay was found in 27% of all cases, being evenly distributed in the two groups. The reason for doctor's delay was usually the doctor's neglecting to perform rectosigmoidoscopy or rectal palpation, and in some cases a false-negative X-ray. No significant correlation was found between tumor stage and doctor's or patient's delay.

Aged↗
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

The frequency of digital and endoscopic examination of the rectum before radiological barium enema.

Doctor's delay in patients with rectal carcinoma is common with a frequency between 30% and 60%. The reason for delay has been supposed to be the neglectance to perform digital examination and rigid proctosigmoidoscopy in patients with symptoms of anorectal disease. Especially general practitioners have been blamed for a high percentage of this kind of doctor's delay. In this study 300 consecutive patients referred for radiological examination of the large bowel have been questioned if digital examination and rigid proctosigmoidoscopy have been performed by their referral doctor. The results show that in 19% of the cases neither digital nor proctosigmoidoscopic examination had been performed. Rigid proctosigmoidoscopy had been omitted in 44%. No statistical difference was observed in the frequency of digital examination between general practitioners (79%) and hospital doctors (84%). The low figures, both for digital examination and rigid proctosigmoidoscopy are probably causing many patients a delay in the diagnosis of a rectal carcinoma. Thus, a more intense evaluation in this area should be applied in the medical faculties and also at post graduate courses.

Adolescent↗
PubMed1986

Recurrence and survival after anterior resection of the rectum using the end to end anastomotic stapler.

With the introduction of the end to end anastomotic stapler there has been an increase in the number of sphincter saving resections for carcinoma of the middle and distal part of the rectum. The results of earlier reports have indicated an increasing number of local recurrences possibly due to less extensive dissection of the lower pelvic area. Ninety-six patients, 46 males and 50 females, with a median age of 68 years (a range in age of 33 to 86 years) were operated upon between 1978 and 1981 for carcinoma of the rectum with anterior resection and stapled anastomosis have been analyzed. All patients were observed for more than three years (a median of 65 months and a range of 36 to 82 months). The hospital mortality rate was 5 per cent. The median distal margin was 2.5 centimeters (a range of 1 to 10 centimeters). Local recurrences occurred in 17 patients. No correlation between the grade of malignant disease and classification according to Dukes' staging and local recurrence was found. The median time between operation and the diagnosis of a local recurrence was 14 months (two to 62 months). Distant metastases developed in 14 of 83 patients who underwent operation for cure. The over-all five year survival rate was 64 per cent. The survival rate for 83 patients who underwent operation for cure was 71 per cent (96 per cent of Dukes' A, 72 per cent for Dukes' B, 45 per cent for Dukes' C and zero per cent for Dukes' D). It is concluded that the use of stapling devices has not been followed by a higher rate of local recurrence or a decreased five year survival rate and that this new technique can be used whenever technically possible.

Adenocarcinoma↗