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Biomedical subjects

H Graffner

Publications and source records attributed to H Graffner.

At least 55 records · Page 3Linked to original sources
PubMed1985

Detection of recurrent cancer of the colon and rectum.

Outpatient follow-up in patients operated upon due to carcinoma of the colon and rectum is usually performed, due to a high rate of recurrence and with the aim of finding a curable recurrence. Due to the enormous cost of an extended follow-up system, a careful evaluation of the benefit is needed. The aim of the present investigation was to study the efficacy of the different tools in an extended follow-up. One hundred ninety patients with carcinoma of the colon and rectum were--apart from traditional clinical follow-up--followed with an extensive laboratory battery including carcinoembryonic antigen (CEA), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), electrophoresis, ALP, and GT. Forty-seven recurrences were found. Thirty-one of these recurrences were first detected by a rise in CEA. Seven cases were detected at clinical follow-up and six cases due to symptoms suggestive of recurrence. The predictive value of a positive test was 79.4% for CEA but very low for the other tests studied. A negative value for any of the tests in the battery was usually accurate. Follow-up after colorectal carcinoma should include CEA as the only laboratory parameter. Postoperative colonoscopy for removal of missed synchronous lesions, chest X-ray, and endoscopic investigations of the anastomotic region also seem to be of value.

Aged↗
PubMed1985

Peptide-containing nerve fibers in the stomach wall of rat and mouse.

Peptide-containing nerve fibers were found to be numerous in the glandular stomach of the rat and mouse. The immunoreactive neuropeptides demonstrated included vasoactive intestinal polypeptide (VIP), peptide histidine isoleucine (PHI), gastrin-releasing peptide (GRP), substance P (SP), enkephalin, somatostatin, cholecystokinin, and neuropeptide Y (NPY). The density and distribution of the various peptide-containing fibers did not differ overtly between the pyloric and oxyntic gland areas except for the GRP fibers, which were fewer in the pyloric than in the oxyntic mucosa. The entire VIP nerve fiber population was found to also contain PHI. Immunoreactive NPY was found to occur in the VIP/PHI fibers (VIP/PHI/NPY fibers) in the smooth muscle and intramural ganglia of both rat and mouse and in the mucosa of the mouse. Mucosal VIP/PHI fibers in the rat did not contain any NPY-like material. Perivascular NPY fibers in both species and mucosal NPY fibers in the rat did not contain VIP or PHI. The mucosa harbored numerous GRP fibers and VIP/PHI (rat) or VIP/PHI/NPY (mouse) fibers, and a modest number of NPY (rat) and SP fibers. In the submucosa the peptide-containing nerve fibers were found mainly in the ganglia and around blood vessels. Blood vessels received a rich supply of NPY fibers; the number of perivascular VIP/PHI, GRP, and SP fibers was much lower by comparison. The smooth muscle and myenteric ganglia harbored not only VIP/PHI/NPY, GRP, and SP fibers but also enkephalin, somatostatin, and cholecystokinin fibers. Gastrin-releasing peptide, VIP/PHI/NPY, SP, and enkephalin nerve cell bodies occurred in the myenteric ganglia. As studied in the rat, vagal denervation did not affect the density and distribution of the various peptide-containing nerve fibers. After sympathectomy, mucosal and perivascular NPY fibers disappeared. The other types of peptide-containing nerve fibers were not affected.

Animals↗
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

Effect of different denervation procedures on catecholamines in the gut.

Sympathectomy has been used to study the role of the sympathetic nervous system in the control of gastric acid secretion. Conflicting results may reflect differences in the sympathectomy procedures used. In a previous study we showed a reduction of catecholamines by more than 90% in the gut wall of the rat after surgical upper abdominal sympathectomy. The aim of the present investigation was to ascertain whether chemical sympathectomy was equally effective and whether total denervation, including combined chemical and surgical sympathectomy together with bilateral truncal vagotomy, would lower the catecholamine levels further. The results showed that chemical sympathectomy reduced noradrenaline levels in fundus (oxyntic) and antrum mucosa to levels similar to those after surgical sympathectomy (less than 5%), but the reduction was less pronounced in the muscle layer of the fundus and antrum and in the pancreas and spleen. Combined surgical and chemical sympathectomy did not reduce noradrenaline more effectively than surgical sympathectomy alone. Vagotomy reduced catecholamines in the stomach by about 50%; in extragastric tissues vagotomy was without effect. Total denervation, including combined surgical and chemical sympathectomy plus vagotomy, did not reduce noradrenaline levels more than surgical sympathectomy alone, suggesting that the proportion of adrenergic fibers that derive from the vagus is quantitatively insignificant but that the vagus exerts a local control of the sympathetic stores of gastric catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

The healing process of anastomoses of the colon. A comparative study using single, double-layer or stapled anastomosis.

In spite of modern suture materials and different techniques in colonic anastomoses after resection, leakage is still the most feared complication in colonic surgery. In female pigs of Swedish land breed, standardized 5-cm long colonic resection was performed 10 cm above the peritoneal deflection, using either a single layer of Gambee-stitches (n = 6, Vicryl 4-0), two-layer interrupted stitches (n = 6, Vicryl 4-0) or the intraluminal stapling device (n = 6, ILS Ethicon). After one week, the animals were sacrificed and an anastomotic index was calculated using in vitro x-ray. Also, anastomotic circulation (calculated by the microsphere technique), breaking strength, and histologic evaluation were performed. All animals survived and no leakage was observed. The time to perform the anastomosis was significantly shorter (P less than 0.05) for the stapling device compared with the manual techniques used. The anastomotic index was lower (P less than 0.05) for two rows (0.24) compared with Gambee-stitches (0.38) or stapler anastomoses (0.37). There were no differences in blood flow among the three groups and no differences in breaking strength. Macroscopic investigation revealed mucosal defects in two of the stapled anastomoses and histologic investigation showed small areas of necrosis. The stapling device did not induce any inflammatory reaction. On the other hand, a severe inflammatory reaction was seen when using conventional suture materials. In conclusion, this study shows that a single row of Gambee-stitches is equal to the ILS stapling device when performing colonic anastomoses and these two methods seem to be superior to the two-layer technique.

Animals↗
PubMed1984

The healing process in high and low anterior resection of the rectum. A comparative study in the pig, using stapling devices.

The reason for the higher leakage frequency after low anterior resection compared with high resection is unexplained. With the development of stapling devices, we have a unique opportunity to investigate anastomotic healing during standardized conditions. In female pigs, six in each group, a high anterior resection was performed by resection of a 5-cm colon segment, 10 cm above the peritoneal fold, and low anterior resection was performed after resection of a 5-cm segment at the peritoneal fold and downward. Differences in healing parameters, i.e., blood flow, breaking strength, and radiologic and histologic appearance between low and high anterior resection, were evaluated. Two leakages occurred after low and none after high anterior resection. The anastomotic index was 0.37 (high) and 0.26 (low) (P less than 0.05). The breaking strength was higher in low resections; this might be due to the thicker wall. There were no differences in blood circulation between high and low anastomoses, but the blood flow was significantly higher in the anastomotic area in both groups. This is probably due to the inflammatory reaction taking place in the healing anastomoses. This study, performed in a standardized fashion with a stapler adjusted to wall thickness and size of the intestine, cannot, on the basis of microcirculation, explain why leakage is more common in lower anastomoses.

Animals↗
PubMed1984

The influence of modified sham feeding on plasma polypeptide (CCK, gastrin, motilin, neurotensin and somatostatin) concentrations in duodenal ulcer disease.

Changes in gastric acid secretion and plasma levels of CCK, gastrin, motilin, neurotensin and somatostatin in response to modified sham feeding (MSF) were investigated in 8 asymptomatic duodenal ulcer patients. MSF caused a significant increase in gastric acid secretion whereas the peripheral plasma concentrations of the various polypeptides remained unchanged. The study gives further support for the notion that MSF activates the vagal innervation to the parietal cells more selectively than insulin hypoglycaemia.

Adult↗
PubMed1984

The possible role of circulating catecholamines in the control of gastric function in health and duodenal ulcer disease.

The relation between gastric acid secretion and plasma concentrations of adrenaline, noradrenaline, dopamine and gastrin was investigated in normal volunteers, adrenalectomized subjects and patients with duodenal ulcer (DU) during digestion and in response to insulin and modified sham feeding (MSF). Basal plasma noradrenaline concentrations were significantly higher in DU patients than in normals whereas basal plasma adrenaline and dopamine concentrations were low in both groups. Basal acid output was similar in the two groups. Insulin markedly increased plasma adrenaline in controls but had no discernible effect in adrenalectomized subjects. Still, there was no difference between acid secretion in the two groups. Insulin, but not MSF, caused a marked increase in plasma catecholamine concentrations in DU patients whereas the acid responses were the same. The significantly increased plasma noradrenaline concentration in DU patients was normalized 6 weeks after highly selective vagotomy but tended to return to the preoperative value 1 year postoperatively. Our results suggest that endogenously released adrenaline might affect gastric function only when present in extremely high plasma concentrations. The pathophysiological role of noradrenaline in DU disease remains obscure.

Catecholamines↗
PubMed1984

Pirenzepine depresses plasma noradrenaline in duodenal ulcer patients.

The effect of pirenzepine--a selective antimuscarinic compound--on plasma catecholamine, serum gastrin and somatostatin concentrations was studied in duodenal ulcer patients. Plasma concentration of noradrenaline decreased significantly after injection of pirenzepine (10 mg intravenously), whereas the circulating levels of adrenaline, dopamine, gastrin and somatostatin remained unchanged. The results may be explained by a decreased activity in postganglionic sympathetic ganglia. This is in line with the recent observation in vitro that pirenzepine effectively blocks muscarinic receptors in some sympathetic ganglia.

Adult↗
PubMed1984

Effects of upper abdominal sympathectomy on gastric acid, serum gastrin, and catecholamines in the rat gut.

Selective upper abdominal sympathectomy increased basal acid output in rats but was without effect on stimulated acid output, serum gastrin concentration, and gastric mucosal histidine decarboxylase activity. The sympathectomy was verified by fluorescence histochemistry and determination of tissue catecholamines. A drastic reduction in tissue noradrenaline, adrenaline, and dopamine levels occurred after sympathectomy, and fluorescence microscopy showed a complete loss of adrenergic nerve fibers. Vagotomy reduced catecholamine levels in the stomach wall by 50% but did not affect the catecholamine content in the pancreas and small bowel. Surprisingly, combined vagotomy and upper abdominal sympathectomy resulted in lower catecholamine levels than sympathectomy alone in extragastric but not in gastric tissues.

Animals↗
PubMed1984

The effect of beta-blockade on gastric acid secretion, gastrin release, and plasma catecholamine concentrations during modified sham feeding in duodenal ulcer patients.

The effects of beta-blockade (propranolol, 100 mg orally) on gastric acid output and on circulating levels of gastrin, adrenaline, noradrenaline, and dopamine during modified sham feeding (MSF) were investigated by a randomized, double-blind method in six patients with asymptomatic duodenal ulcer disease. No differences occurred in peak acid output during MSF, whereas basal acid output was significantly suppressed by beta-blockade and peak acid output was unaffected. Basal gastrin concentration was lower during beta-blockade but rose in response to MSF. Without beta-blockade serum gastrin levels were unaffected by MSF. Plasma catecholamine concentrations were not affected by the beta-blockade. It is concluded that acid output and gastrin release in response to MSF, unlike that to insulin hypoglycaemia, is not influenced by beta-adrenoceptor blockade.

Adult↗
PubMed1984

Conjugated bile salts in gastric aspirates after gastric resection.

Reflux of bile salts into the gastric remnant is believed to have a causal role in the pathogenesis of alkaline reflux gastritis and perhaps also in gastric stump carcinoma. The aim of the present study was to describe changes occurring in conjugated bile acid composition in gastric aspirates from patients with gastric resection. The results show that the total conjugated bile acid concentration was significantly (p less than 0.01) higher in patients with gastric resection (3236 microM) than in a control group (349 microM). The composition of conjugated bile acids in the gastric remnant has a distribution with relatively more deoxycholic acid present than in human bile. This secondary bile acid is known to produce a severer degree of mucosal damage than primary bile acids.

Adolescent↗
PubMed1983

Carcinoembryogenic antigen and lysosomal enzymes in gastric juice as an aid in the diagnosis of gastric cancer.

Malignant transformation in cells is accompanied by enzymatic changes that may be useful markers of malignancy. Studies of oncofetal antigens in gastric juice show an increased concentration in patients with gastric carcinoma. The object of the present study was to test if the concentration of lysosomal enzymes and carcinoembryonic antigen (CEA) were altered in patients with gastric carcinoma compared to patients earlier operated with gastric resection--a supposedly premalignant condition. The results show that no differences could be found in CEA and beta-hexosaminidase levels between the patients with gastric carcinoma and those with gastric resection. However, lysozyme content was significantly higher in gastric carcinoma and might prove useful for screening of patients after gastric resection. Both CEA, beta-hexosaminidase, and lysozyme levels were significantly higher in patients with gastric carcinoma than in a control population, and can therefore have a role in screening of asymptomatic patients.

Adenocarcinoma↗
PubMed1983

Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study.

The need for protective transverse colostomy in low anterior resection using the EEA stapler was tested in a randomized series of 50 patients, half of whom received peroperative protective colostomy. Gastrografin enema on the tenth postoperative day showed a leakage frequency of 30 per cent in both groups. Clinical leakage was noted in 4 per cent (one patient) in the colostomy group and 12 per cent (three patients) in the noncolostomy group. Protective colostomy was followed by stenosis in nine instances, compared with only two in the noncolostomy group (2 alpha = 0.05). Routine protective colostomy should not be used in low anterior resection when the EEA stapling instrument is used. The occasional clinical leakage, which may appear in the postoperative period, can be revealed by close observation and successfully treated by an emergency colostomy. The majority of patients with anterior resection of the rectum, therefore, can be spared the inconvenience and cost of temporary colostomy.

Aged↗
PubMed1983

Is there a relationship between gastric acid secretion and plasma catecholamines in duodenal ulcer disease?

Plasma adrenaline, noradrenaline and dopamine concentrations have been analyzed in three different groups of duodenal ulcer (DU) patients under various regimens of acid reduction in an attempt to find out if acidity per se has any influence on plasma catecholamine concentrations. Treatment with cimetidine in patients with asymptomatic chronic DU disease, reduced gastric acidity to the same level as after highly selective vagotomy (HSV), but increased plasma noradrenaline concentrations insignificantly. In a group of DU patients subjected to HSV, plasma noradrenaline levels were significantly higher 1 year after surgery than 6 weeks thereafter despite the fact that the basal acid output was the same. In a third group of DU patients, plasma noradrenaline and dopamine levels were found to be 20% higher during the active, untreated ulceration than after 4 weeks of ranitidine treatment when the ulcer had healed. It is concluded that the elevated plasma noradrenaline levels found in DU patients are not caused by the hypersecretion of acid per se, nor does there seem to be any general correlation between acidity and the catecholamine levels in peripheral plasma.

Catecholamines↗
PubMed1983

The effect of highly selective vagotomy on sick-listing in peptic ulcer patients.

The amount of sick-listing in 75 patients operated on with highly selective vagotomy (HSV) was studied during two periods, the first consisting of 12 months and ending 1 year before operation and the second period, also consisting of 12 months, starting 1 year after operation. Patients with suspected ulcer recurrences were excluded and only patients who, at the 1-year postoperative follow-up study, were without symptoms suggestive of ulcer recurrence are included. The median amount of sick days was 31.3 for the period preceding and 37.2 (NS) after the operation. Before operation 60% of all sick-leave diagnoses were ulcer or gastritis, compared with 20% after operation. A 50% increase in infectious diseases and lumbago occurred. Psychiatric disorders rose from 1 to 16 occasions. We therefore conclude that patients apparently cured of chronic ulcer disease change target and develop symptoms elsewhere. The study shows no potential economic benefits of HSV, at least not with regard to a diminishing amount of sick days after operation.

Adolescent↗
PubMed1983

The role of catecholamines in the control of gastric acid secretion during insulin hypoglycaemia and modified sham feeding.

The modified sham feeding procedure has been advocated to replace the insulin test as the method of choice for the assessment of denervation after vagotomy. One of the reasons for this changing attitude is the assumption that insulin hypoglycaemia causes non-cholinergic stimulation of acid secretion, possibly mediated via the sympatho-adrenal system. This study has therefore compared the effects of these two different tests on acidity and release of catecholamines into the circulation in 7 duodenal ulcer patients 6 weeks after highly selective vagotomy. It was found that insulin, but not modified sham feeding, caused a marked increase in plasma adrenaline and noradrenaline concentrations whereas gastric acid secretion was of a similar magnitude in the two tests. The results suggest that the increased plasma catecholamine levels during insulin hypoglycaemia do not influence gastric acid secretion in duodenal ulcer patients.

Adult↗