Biomedical subjects

H Norlén

Publications and source records attributed to H Norlén.

At least 19 recordsLinked to original sources

PubMed1993

A comparison between intermittent and continuous transurethral resection of the prostate.

123 transurethral resections of the prostate were studied. The operations were randomized to either continuous or intermittent technique. The first 64 operations were performed using an irrigating fluid pressure head of 65 cm (measured from the top of the operating table). In the rest of the operations an 80 cm pressure head was used. In this way four groups were obtained comprising 30 to 31 patients, differing from each other in respect of irrigating technique. Isotonic 5% mannitol solution was used as an irrigating fluid. The irrigating fluid absorptions were calculated from the plasma mannitol levels determined immediately postoperatively. The use of a trocar significantly lessened the average absorbed fluid volume, while there was no significant difference between the groups of high and low irrigating fluid pressure head. The intraoperative bleeding, the decrease in serum sodium, the resection time and resection rate did not differ significantly between the four groups.

Aged↗

PubMed1993

Absorption of irrigating fluid during percutaneous transrenal lithotripsy.

Twenty-eight patients who underwent percutaneous lithotripsy with isotonic mannitol solution as the irrigating fluid were studied. Intraoperative intravenous and total absorption of irrigating fluid was estimated from postoperative analyses of plasma and urinary concentrations of mannitol. Most operating times were short and only minor fluid absorption was recorded. In six cases, however, the fluid absorption exceeded 100 ml and two of these had a maximal calculated absorption of more than 1000 ml (1220 and 1860 ml, respectively). Intraoperative bleeding was a warning sign of absorption of irrigating fluid.

Absorption↗

PubMed1992

A comparison between two hypotonic irrigating solutions used in transurethral resections of the prostate: sorbitol (2%)-mannitol (1%) and 1.5% glycine solutions.

Two hypotonic but non-haemolysing irrigating solutions, sorbitol-mannitol (2% + 1%) and glycine (1.5%), were compared in 40 TURP cases using a continuous resection technique. Ethanol (1%) was added to the irrigating fluid as a marker to make possible early detection of fluid absorption by breath analysis. Mannitol and sorbitol were determined in plasma and urine; glycine and ethanol were determined in plasma. Apparent absorbed fluid volumes were calculated from the immediate postoperative plasma concentrations of ethanol, mannitol, sorbitol and glycine and from the elimination of mannitol in urine during 24 hours following the operation. The use of a continuous operating technique with a suprapubic trocar resulted in very small absorptions (less than 1 l) in this series. The concentrations of the two solutes in the sorbitol-mannitol irrigating fluid were balanced so that the plasma concentrations immediately postoperatively were of the same order when absorption occurred. The sorbitol concentration declined more rapidly than the mannitol concentration in conformity with previous findings. In most cases the peak plasma level was observed immediately postoperatively but in some cases at a later time (during the interval 0-2 hours), indicating absorption from a depot of fluid accumulated extravesically in addition to direct intravenous absorption. The best estimate of fluid absorption seems to be obtained from the urinary elimination of mannitol, followed by estimates based on the plasma mannitol concentration immediately postoperatively. The plasma ethanol level determined at the same time gave an estimate of the same order, whereas plasma sorbitol and glycine levels gave lower estimates (owing to rapid redistribution and metabolism).(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1990

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. I. Distilled water as an irrigating fluid.

10 patients undergoing transurethral resection of the prostate using sterile distilled water as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water and electrolytes and the free amino acid concentrations in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2 hours postoperatively. The content of water and concentrations of electrolytes in skeletal muscle did not change significantly from the preoperative to the postoperative period with the exception of the potassium concentration, which decreased 2 hours postoperatively. The following free amino acid concentrations in muscle tissue showed significantly decreased values 2 hours postoperatively compared with the preoperative values: taurine, serine, glutamate, proline and leucine. The concentrations of non-essential amino acids in muscle decreased significantly 2 hours postoperatively. This may be interpreted as a dilution effect. An increased concentration of some amino acids in plasma postoperatively may be explained as a haemoconcentration effect due to the use of a postoperative diuretic.

Aged↗

PubMed1990

Water and electrolytes in muscle tissue and free amino acids in muscle and plasma in connection with transurethral resection of the prostate. II. Isotonic 2.2% glycine solution as an irrigating fluid.

Seventeen patients undergoing transurethral resection of the prostate using isotonic 2.2% glycine solution as an irrigating fluid were studied. The extra- and intracellular distribution of water, the total content of water, and the concentrations of electrolytes and free amino acids in muscle tissue were determined together with the concentrations of free amino acids in plasma preoperatively, immediately postoperatively and 2, 6, 24 and 48 hours postoperatively in two groups with separate sampling periods. There were no significant changes in water content and sodium or chloride concentrations in muscle tissue postoperatively. Potassium and magnesium concentrations decreased late in the postoperative phase. In plasma there was a fifty-fold increase immediately postoperatively in the glycine concentration (mean fluid absorption 0.71) followed by a six-fold increase in muscle tissue 6 hours postoperatively. The glycine metabolite serine also increased in plasma and muscle. Other muscle amino acid concentrations decreased immediately postoperatively probably due to the massive glycine entrance into the cells. Later postoperative changes in some muscle amino acids (glutamine, glutamate, alanine, tyrosine and arginine) may be explained more by the operative trauma than by the influence of glycine. Two different types of metabolic effects are seen in this material. The first is that of the glycine infusion and the metabolic effects of glycine. The second is the catabolic influence of the surgical trauma. Accumulation of glycine in tissues in some patients with the possible production of ammonia and the effects of glycine as an inhibitory neurotransmitter must be considered as risk factors when choosing glycine as an irrigating fluid.

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PubMed1989

Transurethral resection of the prostate. A review of 1111 cases.

A review of 1111 transurethral resections of the prostate (TURP) revealed a mortality of 0.5% (6 patients). A stricture frequency of 3% was observed as a complication after the operation. A supplementary resection was done within one year in 9%. Transurethral resection syndrome of the prostate (TURP syndrome) occurred in two patients. Cancer incidence was 18%. Blood transfusions were given to 20% of the patients. The weight of resected prostatic tissue ranged from 4 to 115 g (mean 25 g), and was less than 20 g in 60%. Peroperative bleeding amounting to over 1800 ml occurred in 3.3% (37 patients).

Adult↗

PubMed1988

Testicular hydrocele treated by bismuth phosphate injection.

Thirty-eight testicular hydroceles were treated by injection with 0.2-0.4 g of bismuth phosphate. The follow-up was completed in 32 cases, 17 (53%) of which showed complete regression although one patient had to wait 24 months for full regression. Eight patients (25%) showed clinical improvement and one patient (3%) had residual scrotal tenderness after otherwise successful treatment. Six patients (19%) did not improve and were treated surgically. The method may present an alternative to surgery in elderly patients with testicular hydrocele.

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PubMed1988

Absence of lactate accumulation on transurethral resection of the prostate using 2.5% sorbitol solution as an irrigating fluid.

19 patients with benign hyperplasia of the prostate were studied. During transurethral resection of the prostate, 2.5% sorbitol solution was used as an irrigating fluid. Blood samples were taken preoperatively, immediately postoperatively, and 60 and 120 min postoperatively. Samples were analysed for sorbitol metabolites (fructose, glucose, lactate and pyruvate) and inorganic phosphate. The series was divided into two groups, one with low absorption and one with high absorption of irrigating fluid. The limit for the plasma sorbitol concentration immediately postoperatively, dividing the groups, was 1.0 mmol/l, corresponding to an absorbed fluid volume of about 0.1 l. There was a slight increase in lactate and a significant decrease in pyruvate in the blood in both groups postoperatively. Blood fructose was zero in the group with low absorption of irrigating fluid whereas there was a slight increase in the group with high absorption, with a maximum of 0.53 mmol fructose/l. Blood glucose did not show any significant changes postoperatively. Inorganic phosphate in serum showed a significant decrease postoperatively in both groups. There were no significant differences between the groups at the various postoperative sampling times with regard to lactate, pyruvate, glucose or inorganic phosphate in the blood. Thus, we did not observe any accumulation of lactate in the blood when using 2.5% sorbitol solution as an irrigating fluid with absorbed fluid volumes up to 1 litre (corresponding to 25 g sorbitol).

Blood Glucose↗

PubMed1987

Plasma haemoglobin concentrations and other influx variables in blood in connection with transurethral resection of the prostate using distilled water as an irrigating fluid.

Eight patients undergoing transurethral resection of the prostate (TURP) using sterile distilled water as an irrigating fluid were studied. The concentrations of plasma haemoglobin, serum sodium, serum prostatic acid phosphatase protein (PAP) and plasma osmolality were determined as possible indicators of absorption of irrigating fluid. In 3 patients there was a marked increase in plasma haemoglobin immediately postoperatively with a maximum of 3.3 g haemoglobin/l plasma. In the remaining 5 patients the plasma haemoglobin level did not exceed 0.7 g/l immediately postoperatively. In all cases there was a fairly rapid return of the elevated plasma haemoglobin level to preoperative values. There was also a postoperative increase in the serum PAP level which was not correlated with the simultaneous increase in plasma haemoglobin concentration. There was no significant change in the sodium, potassium or albumin concentration in serum nor in plasma osmolality postoperatively. There was some decrease in the postoperative serum creatinine and uric acid levels. The preoperative serum creatinine concentration was within reference limits in 7 patients and borderline high in 1 patient. The haemoglobin binding plasma protein haptoglobin showed a slight non-significant increase immediately postoperatively and a significant decrease in concentration 2 hours postoperatively. The mean plasma haemoglobin concentration immediately postoperatively did not exceed the mean preoperative haemoglobin binding capacity of serum. The mean preoperative haemoglobin binding capacity was 1.2 g/l and the mean plasma haemoglobin level was 1.2 g/l immediately postoperatively. Two hours later the mean plasma haemoglobin level was 0.8 g/l. The mean serum haptoglobin concentration was 2.4 g/l preoperatively, 2.6 g/l immediately postoperatively and 2.0 g/l 2 hours later.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗

PubMed1987

Experience with hypotonic 2.5% sorbitol solution as an irrigating fluid in transurethral resection of the prostate.

19 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and hypotonic 2.5% sorbitol solution as an irrigating fluid. No diuretics were given postoperatively. In 2 patients there was a slight elevation of the serum creatinine level preoperatively but in 17 patients serum creatinine was within the reference limits. The plasma sorbitol concentration was determined at 20-min intervals for two hours. The mean plasma concentration of sorbitol immediately postoperatively was 379 mg/l (2.1 mmol/l) and the highest level observed was 1,900 mg/l (10.6 mmol/l). The half-life for sorbitol in plasma was 21 min (mean calculated in 11 cases). The range was 11-33 min. With increasing immediate postoperative plasma sorbitol levels there was also an increase in the half-life, corresponding to saturation of the sorbitol metabolizing enzyme system. The absorbed fluid volumes were calculated from the immediate postoperative plasma concentration of sorbitol, which gave a mean of 0.23 1 and a maximum of 1.01. Haemodilution effects with decrease in the serum sodium and serum albumin concentrations were noted, but they were much less marked than when 5% sorbitol solution was used as an irrigating fluid. There were only insignificant increases in the plasma haemoglobin concentrations postoperatively, which were probably due to heat decomposition of red blood cells in the bladder during the operation. About 7% of the absorbed amount of sorbitol was eliminated in the urine (mean). The highest value observed was 18% in the case showing the highest plasma sorbitol concentration immediately postoperatively (1,900 mg/l). Sorbitol was eliminated in the urine over a period of 6 hours postoperatively.

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PubMed1987

Absorption and elimination of mannitol solution when used as an isotonic irrigating agent in connection with transurethral resection of the prostate.

12 patients were studied in connection with transurethral resection of the prostate using the intermittent technique and isotonic 5% mannitol solution as an irrigating fluid. No diuretics were given postoperatively. The serum creatinine concentrations were normal in 10 patients and slightly elevated in 2. The plasma mannitol levels were followed for four hours postoperatively. The highest concentration observed in the series was 6,275 mg/l (34.9 mmol/l) immediately postoperatively. The maximum level was observed immediately postoperatively in all patients (mean 2,140 mg/l, 11.9 mmol/l). The mean half-life of mannitol in plasma was 163 min (10 patients). The patient with the highest serum creatinine concentration preoperatively (138 mumol/l) showed a marked prolongation of the half-life (692 min). The mean intravenous fluid absorption calculated from the immediate postoperative mannitol concentrations was 0.68 l (range 0.05-1.78 l). A decrease in the serum sodium concentration was observed immediately postoperatively (mean 5.4 mmol/l, range 0-19 mmol/l). There was a correlation between the decreases in the serum sodium concentration and the simultaneous plasma mannitol concentration. There was no significant change in plasma osmolality. Mannitol elimination in urine was followed for 24 hours postoperatively in 7 patients. The mean absorbed volume of irrigating fluid was calculated from the elimination data and was found to be 0.481, which should be compared with the figure obtained from the calculation based on the immediate postoperative plasma mannitol concentration, which gave 0.49 l (mean) in the same 7 patients. This shows that, in spite of the theoretical assumptions made in the calculation of absorbed fluid volume from the plasma mannitol concentration, this method of calculation is valid.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1986

Sorbitol concentrations in plasma in connection with transurethral resection of the prostate using sorbitol solution as an irrigating fluid.

20 patients undergoing transurethral resection of the prostate (TURP) using 5% sorbitol (N = 13) or Cytosol (N = 7) (5% sorbitol and 0.25% acetic acid) as an irrigating fluid were studied. The sorbitol concentration was determined in serum (plasma), as were sodium, prostatic acid phosphatase protein (PAP) and osmolality, as possible indicators of absorption of irrigating fluid. The plasma level of sorbitol immediately postoperatively, the increase in serum PAP and the decrease in serum sodium all reflect the amount of irrigating fluid absorbed during TURP. The three variables are intercorrelated. The plasma osmolality was not significantly changed. The maximum sorbitol concentration immediately postoperatively in any patient was 6.0 g/l (33.5 mmol/l). The mean for the series was 1.2 g/l (6.8 mmol/l). The mean serum PAP increase was 31 micrograms/l. The serum sodium decrease ranged between 0 and 14 mmol/l, mean 5.0 mmol/l. The mean half-life of sorbitol in plasma was short: 35 min, reflecting rapid metabolism. An estimate of the volume of fluid absorbed was made from the plasma sorbitol levels observed. A fluid absorption up to 2.3 l (mean 0.6 l) was found. A marked diuretic effect up to 14.1 ml/min (mean 7.8 ml/min) was observed in some cases when irrigation with sorbitol was combined with intravenous furosemide given postoperatively.

Aged↗

PubMed1986

Glycine solution as an irrigating agent during transurethral prostatic resection. Glycine concentrations in blood plasma.

In 17 men undergoing transurethral resection of the prostate (TURP), an isosmotic solution of 2.2% glycine was used for irrigation. The plasma glycine concentration was determined before and immediately after TURP and 2, 6, 24 and 48 hours later. The serum concentrations of sodium, albumin and prostatic acid phosphatase protein (PAP) were used as indicators of fluid absorption. Calculation of the absorbed fluid volume was based on the plasma concentration of glycine, and the disappearance rate of glycine from plasma was estimated. The mean disappearance rate (T 1/2) was 85 min, which was midway between previously observed rates for sorbitol and mannitol. The observed plasma glycine increase after TURP correlated well with fall in serum sodium and rise in serum PAP, with the blood loss during and up to 15 min after TURP, and also with the weight of the resected tissue. The plasma glycine level, highest immediately after TURP, normalized 24-48 hours postoperatively. No signs of ammonia intoxication or marked serum urea increase were seen in these patients, although some had very high plasma glycine values after TURP (mean 10.2, maximum 23 mmol/l) as compared with the preoperative levels (mean 0.2 mmol/l). There was some increase of plasma serine (a normal metabolite of glycine) after TURP. The authors conclude that the irrigating fluid should have a minimal concentration of glycine, near to the level of haemolysis onset, to minimize the plasma dilution effects, including hyponatraemia, and the appearance of metabolites when the irrigating fluid is absorbed.

Acid Phosphatase↗

PubMed1986

Mannitol concentrations in blood plasma in connection with transurethral resection of the prostate using mannitol solution as an irrigating fluid.

Thirteen patients undergoing transurethral resections of the prostate (TURP) using iso-osmolar 5% mannitol as an irrigating fluid were studied. Mannitol was determined in serum (plasma), as were sodium, prostatic acid phosphatase protein (PAP) and osmolality as probable indicators of absorption of irrigating fluid. The plasma level of mannitol (mean 2.7 g/l = 15 mmol/l) immediately postoperatively, the increase in serum PAP (mean 93 micrograms/l) and the decrease in serum sodium (mean 8.7 mmol/l) all reflect the amount of irrigating fluid absorbed during TURP. The three variables are intercorrelated. The plasma osmolality was unchanged (mean -1 mosmol/kg). A small but constant fraction of mannitol was found in the erythrocytes 2 hours after the operation, amounting to about 3% of the simultaneous plasma concentration. The mean plasma half-life of mannitol was 127 min in the absence of uraemia. In two cases showing a slight increase in serum creatinine the half-lives were prolonged. An estimate of the volume of fluid absorbed was made from the observed plasma mannitol levels. A fluid absorption of up to 3 litres (mean 1.1 l) was found. A strong diuretic effect was observed in some cases when irrigation with mannitol was combined with i.v. furosemide. We conclude that the i.v. diuretic should be withheld until the extent of fluid absorption has been estimated. If the sodium concentration in the serum is largely unchanged immediately postoperatively, diuresis can be induced by an intravenous diuretic.

Absorption↗

PubMed1986

Influence of various irrigation fluids on serum enzyme patterns following transurethral resection of the prostate.

Serum levels of a variety of enzymes were determined preoperatively and repeatedly postoperatively in a comprehensive biochemical study of 60 patients undergoing transurethral resection of the prostate (TURP). These patients were divided into four groups depending on the type of fluid used for irrigation during TURP. Prostatic acid phosphatase (PAP, analysed by radio-immunoassay) in serum showed a marked postoperative increase but wide inter-individual variation in all groups. It returned to normal within 24 to 48 hours. When water was used for irrigation, similar but less pronounced increases were observed for serum lactate dehydrogenase (LD, LD-1) and aminotransferases (ASAT, ALAT). This is interpreted as being due to an influx of irrigating fluid into the general circulation from the bladder through opened veins, by absorption from a perivesical accumulation or, in the case of PAP, also from the prostatic wound. The enzyme increases (other than PAP) may be due to their release from haemolysed red cells in the bladder or in a perivesical fluid accumulation, which conjecture is supported by the marked increase also seen in plasma haemoglobin. When iso-osmolar fluids were used for irrigation signs of haemodilution, such as a postoperative decrease in serum sodium, were observed. Several of the variables studied may be used as markers to indicate the quantity of irrigating fluid absorbed during resection. Plasma haemoglobin, serum LD (or LD-1) in connection with water irrigation, serum sodium in connection with iso-osmolar fluid irrigation and serum PAP, regardless of the type of irrigating fluid used, are some practical suggestions for such markers.

Acid Phosphatase↗

PubMed1985

Isotonic solutions of mannitol, sorbitol and glycine and distilled water as irrigating fluids during transurethral resection of the prostate and calculation of irrigating fluid influx.

The aim of the study was to evaluate the clinical properties of some irrigating fluids used in transurethral resection of the prostate, to study humoral changes and disposition of the various fluids and solutes on intravenous absorption and, finally, to draw conclusions concerning a suitable composition of irrigation fluid. 60 patients undergoing transurethral resection of the prostate were included in the study. Plasma concentrations of mannitol, sorbitol and glycine were determined (during and after operation) as indicators of intravenous irrigation fluid influx. The serum concentration of prostatic acid phosphatase and, in patients irrigated with distilled water, the postoperative increase in plasma haemoglobin and the serum lactate dehydrogenase increase were used as semiquantitative estimates of fluid influx. A wide-ranging series of biochemical analyses was performed on blood in all cases before, during and after the resection (inter alia, sodium, albumin, haptoglobin in serum). The half-lives in plasma were estimated for mannitol, sorbitol and glycine. Fluid absorption was calculated in several ways. Haemodilution occurred with all iso-osmolar solutions on absorption but not with distilled water. The dilution effect of glycine solution was the most pronounced. Calculation of absorbed fluid volumes gave values up to 3.0 litres. Plasma osmolality was unchanged with all irrigating fluids used. The half-life in plasma for sorbitol was about 30 min, for glycine about 90 min and for mannitol about 120 min. Glycine entered muscle cells and changed the amino acid pattern. There was an increase in the serine and ammonia concentrations in plasma postoperatively. On absorption of distilled water there was an increase in the concentration of plasma haemoglobin and in erythrocyte-derived enzymes. The immediate postoperative concentration of glycine, mannitol and sorbitol in plasma was used to calculate fluid absorption. These concentrations showed good correlation with the immediate postoperative decrease in serum sodium concentration. The serum sodium decrease can be used for calculations of the absorbed fluid volume. On absorption of large volumes of water with haemolysis products, kidney damage is possible. The osmotic diuretic effect of mannitol gives a tendency to low postoperative blood pressure if combined with an intravenous diuretic. Water as an irrigating fluid can be recommended for diagnostic purposes and for general bladder surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

PubMed1983

Concealed haematuria--whence cometh the bleeding? A new method of localisation.

Concealed haematuria is often a difficult diagnostic problem. A method for collecting isolated urine specimens from different areas of the urinary tract and subjecting them to quantitative analysis for RBCs is described. A more accurate localisation of the source of bleeding with, in the upper urinary tract, side differentiation, is thus possible. Some examples are presented as case reports.

Adult↗

PubMed1980

Estramustine versus conventional estrogenic hormones in the initial treatment of highly or moderately differentiated prostatic carcinoma. A randomized study.

In a prospective randomized multicenter trial patients with highly or moderately differentiated prostatic carcinoma, previously untreated, were allotted either to oral Estramustine phosphate or to intramuscular polyestradiol phosphate plus oral ethinyl estradiol. As regards frequency and duration of tumour remission there was no statistical difference between the two groups. Nor did they differ significantly with respect to adverse reactions. This is an interim report and will be followed later on by a final evaluation.

Bone Neoplasms↗