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Biomedical subjects

I Ihse

Publications and source records attributed to I Ihse.

At least 181 records · Page 10Linked to original sources
PubMed1981

[Organization of diagnosis, treatment, and further measures for patients with gastrointestinal cancer (author's transl)].

One third of the total surgical care at the Department of Surgery, University of Lund, Sweden, is for cancer patients. Gastrointestinal cancer occupies 9,000 of a total of 12,000 bed-days and this disease is usually handled by the team who cares for the specific organ in which the cancer is localized. A particularly important part of gastrointestinal care is endoscopy (gastroscopy and colo-sigmoideo-rectoscopy). These diagnostic procedures can sometimes be curative. The value of preoperative liver tests for diagnosing liver metastases in colorectal cancer is very low because of the low prevalence of liver metastases in this population. Palliative therapeutical procedures, such as Celestin-tubes for esophageal or cardia carcinoma and transhepatic endoprostheses for bile duct occlusive cancer, have been tested. Palliative cytostatic therapy is partly established, i.e., intraarterial infusion of 5-FU for recurrent rectal carcinoma in the lower pelvis. This type of treatment has a very good pain relief effect. Cytostatic therapy for tumour control in patients without symptoms e.g. primary or secondary liver carcinomas, has not yet been established. Most of the patients with cytostatic therapy are treated on an outpatient basis. The cytostatic therapist must always be properly protected when working with cytostatic drugs. It is very important that the patient who gets cytostatic therapy is followed in order to see if the drug has any growth-controlling effect. A cost-benefit analysis of the therapy should also be made.

Antineoplastic Agents↗
PubMed1981

Regional, portal hypertension in chronic pancreatitis.

Because of a close anatomical relationship to the splenic vein chronic pancreatitis can cause obstruction to the splenic outflow. Regional portal hypertension develops and collateral flow sometimes gives rise to gastric and oesophageal varices which can cause life-threatening bleeding. Three cases with regional portal hypertension secondary to chronic pancreatitis are presented. Two of them were treated with surgical splenectomy and the third had an embolization of the splenic artery. Regional portal hypertension should be suspected in a patient with a history of chronic pancreatitis who is bleeding from gastric of oesophageal varices. The treatment of choice is surgical splenectomy. In high risk patients embolization of the splenic artery can be tried.

Adult↗
PubMed1981

Gastrointestinal bleeding caused by haemosuccus pancreaticus. A presentation of two cases.

Two cases of gastro-intestinal bleeding due to haemosuccus pancreaticus (hemorrhage through the pancreatic duct) are presented. Both patients had hematemesis and melena in combination with epigastric pain and hyperamylasemia. Angiography revealed aneurysms of the splenic artery as the probable source of bleeding. Central ligation of the splenic artery with splenectomy cured both patients. Angiographic obliteration of the splenic aneurysm was used preoperatively in one case.

Adult↗
PubMed1980

A large-bore teflon endoprosthesis with side holes for nonoperative decompression of the biliary tract in malignant obstructive jaundice.

A large-bore Teflon tube with side holes was used for nonsurgical palliative bile drainage in eight patients with malignant tumors. The drainage period ranged from 5 to 26 weeks. The bile drainage through the endoprosthesis was regarded as optimal in two patients, satisfactory in four, and ineffective in two. Significant complications of the method are intervening bile duct infections, risk of sepsis, spontaneous dislodgement, and occlusion of the endoprosthesis.

Adult↗
PubMed1980

Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts.

The records of 80 consecutive patients with extrahepatic bile duct cancer, 45 women and 35 men, median age 70 years (33-89 years), were reviewed. The histologic diagnoses were adenocarcinoma in 45 patients, 34 cholangiocarcinoma and one squamous cell carcinoma. In 34 patients the tumor was located to the confluence, the right or left hepatic duct, in 16 to the middle and in four to the distal portion of the bile duct. In the remaining 26 patients the tumor comprised more than one of these locations (mixed location). Twenty-seven of the 80 patients (34%) were operated on with resection of the tumor. Among patients 70 years of age and younger the resectability rate was 57%. In nine patients the main surgical procedure was bile duct resection, in 15 patients bile duct resection and liver lobe resection, in 2 patients total pancreatectomy and in one local excision were performed. The resection of the tumor was regarded as radical in 12 patients and palliative in 15. The mortality rate was 11% after resection as compared to 30% in patients with nonresectable tumors. The most common postoperative complication was insufficiency of the anastomosis which occurred in seven patients. Three of these patients required reoperation. The median survival time in patients operated on with radical resection was 20 months, palliative resection 7(1/2) months and in patients with nonresectable tumors 2(1/2) months. The quality of life was estimated according to a special schedule and was found to be improved after resection as compared to nonresection. Patients operated with radical resection spent significantly less of their remaining life at hospital as compared to palliatively resected patients or patients with nonresectable tumors.

Adenocarcinoma↗
PubMed1980

Cimetidine treatment in acute experimental pancreatitis.

The effects of cimetidine on acute experimental pancreatitis was studied in the rat. Acute pancreatitis was induced in a highly standardized manner, using transduodenal injection of sodiumtaurodeoxycholate and trypsin, into the bile-pancreatic duct. Subcutaneous injections of 32 mg/kg body weight of cimetidine every 8 h did not influence the severity of pancreatitis as evaluated on basis of mortality, macroscopic evaluation, S amylase and amylase activity in ascites or amylase and lipase activity within pancreatic tissue. When, however, the dose of cimetidine was increased tenfold, a significantly increased mortality rate was observed as compared to normal rats given either dose of cimetidine and to pancreatitic rats given the low dose of the drug. Our study does not justify the use of cimetidine in acute pancreatitis.

Acute Disease↗
PubMed1980

Vagal influences on the pancreatic response to intraluminal trypsin.

The significance of vagal influences on the pancreatic response to intraluminal trypsin was investigated in conscious rats surgically prepared with bile-pancreatic fistulae. Vagotomy as well as cholinergic blockage depressed the hypersecretion of protein in fistula rats. Contrary to in control rats intraduodenal trypsin infusion did not change the protein output after vagotomy or cholinergic blockage. Indirect vagal stimulation induced by insulin hypoglycemia did not further increase the protein output in rats with their bile-pancreatic juice deviated from the intestine. In these latter rats, however, intraduodenal infusion of trypsin markedly inhibited the protein secretion. The results suggest that vagal integrity is essential for the response of the pancreas to intraduodenal trypsin.

Animals↗
PubMed1980

Percutaneous transhepatic portography in pancreatic carcinoma. Diagnosis and evaluation of resectability.

In 33 patients with carcinoma of the head of the pancreas, both angiography and percutaneous transhepatic portography combined with selective phlebography of the pancreatic veins were performed. The tumour diagnosis was made in 28 patients by angiography and in 21 by phlebography. Correlation was found between extrapancreatic artery encasement, involvement of the main stems of the portal vein system and non-resectability of the tumour. In 5 patients venous involvement demonstrated by portography was the only indication of non-resectability of the tumours.

Angiography↗
PubMed1980

Intestinal concentrations of pancreatic enzymes following pancreatic replacement therapy.

The activities of amylase, lipase, phospholipase, and trypsin in four commercially available preparations of pancreatin with different galenic and adjunctive protective properties were estimated in vitro, using human small-intestinal juice as the incubation medium. These preparations were administered to healthy subjects and to patients with severe pancreatic insufficiency, and their ability to increase the intestinal concentrations of pancreatic enzymes was evaluated. The relations between in vitro and in vivo activities were also studied. In vitro testing showed that the preparations contained high but varying activities of enzymes, with the greatest variations in lipase and trypsin. Pancreatin in the form of tablets, with or without protective measures against acid, did not cause any apparent increase in the activities of pancreatic enzymes in the upper part of the gut in patients with pancreatic insufficiency. Granulated pancreatin, on the other hand, brought about an increase in the activities of amylase, phospholipase, lipase, and trypsin. Relatively higher activities of the enzymes in granulated form reached the small intestine as compared with those of the tablets.

Amylases↗
PubMed1980

Intraarterial 5-FU infusion with or without oral testolactone treatement in irresectable pancreatic cancer.

The results of a prospective study of 19 patients with pancreatic cancer treated with regional intraarterial 5-FU infusion with or without oral tesolactone are reported. No primary mortality was noted. No measurable tumor remission was seen. The median survival time from the state of infusion therapy was 6.5 months. Median time of hospitalization from the start of infusion therapy was 2 months, which corresponds approximately to 30% of remaining survival time. No significant improvement of quality of life was registered during the treatment period. The results indicate that intrrarterial regional 5-FU--neither with nor without testolactone--cannot be recommended for patients with irresectable pancreatic cancer.

Adult↗
PubMed1979

Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts.

A Teflon endoprosthesis for permanent bile drainage was inserted in 13 patients following percutaneous transhepatic puncture and catheterization of the bile duct system. Twelve patients had extrahepatic cholestasis because of a malignant tumor, whereas one patient had chronic inflammation involving the hepatoduodenal ligament (secondary to Crohn's disease) with obstruction of the extrahepatic bile ducts. The drainage periods varied from 1 week to 8 months. The endoprosthesis was regarded as partially effective in seven patients whereas in six cases the drainage through the endoprosthesis was insufficient and external bile drainage through a percutaneous transhepatic catheter was necessary. Infection of the bile duct system during the drainage period with a percutaneous transhepatic catheter and/or bile duct endoprosthesis occurred in 10 patients. Spontaneous dislocation of the endoprosthesis occurred in varying degrees in five patients. One patient developed an intrahepatic aneurysm adjacent to the puncture tract and died because of liver insufficiency following therapeutic embolization of the aneurysm and most of the hepatic arteries by injection of gelfoam particles into the common hepatic artery. Patients in whom palliative treatment by insertion of a permanent bile duct endoprosthesis may be suitable were defined.

Adult↗
PubMed1979

Percutaneous transhepatic portography in bile duct carcinoma. Correlation with percutaneous transhepatic cholangiography and angiography.

In 16 patients with carcinoma of the extrahepatic bile ducts, percutaneous transhepatic portography (PTP) and cholangiography (PTC) were performed. Fourteen of these patients also had angiography, which failed to show the tumor in 7 cases. Findings indicating non-extirpability of the tumor were demonstrated by angiography in 3 patients. At PTP non-extirpability was confirmed in these cases. PTP further indicated non-extirpability in one patient and gave hints of infiltration of the liver by the tumor in 5 patients because of intra or extrahepatic invasion of the portal vein.

Adenoma, Bile Duct↗
PubMed1979

Intraoperative fine needle aspiration cytology in pancreatic lesions.

The notes of 129 patients investigated by intraoperative fine needle aspiration biopsy between 1973 and 1977 have been reviewed. Eighty-four of the patients were operated on and punctured at the Department of Surgery, Lund, and 45 at different county hospitals belonging to the region. All aspirates were stained and evaluated at the Department of Cytodiagnostics, Lund. Sixty-four of the 75 patients with pancreatic cancer were correctly diagnosed and in another three patients the cytological diagnosis was "suspicion of cancer." Including these latter cases the sensitivity of the method was 91% in pancreatic cancer. In four out of five patients with endocrine tumors the cytological report was correct i.e., "endocrine tumor." In none of 22 patients with chronic pancreatitis or pancreatic cysts the diagnosis was falsely positive. Twenty-seven patients who during the operation were suspected of having a pancreatic lesion were at follow-up (mean 2.8 years) found not to have any significant pancreatic disease. Among these patients no falsely positive reports were given. In nine of the 129 patients (7%) the aspirates even at re-checking were found to be nonrepresentative or the aspiration unsuccessful. Six of these were performed at county hospitals. In 24 patients with pancreatic cancer total pancreatectomy was performed. In the remaining 105 patients no complications which could be related to the puncture were detected.

Biopsy, Needle↗
PubMed1979

Pancreatic enzymic activities of commercial pancreatic enzyme preparations incubated in human small intestinal juice.

The activities of amylase, lipase, phospholipase and trypsin of twelve commercial pancreatic enzyme preparations were measured under identical conditions. Human small intestinal juice was chosen as incubation medium. A wide variation of enzymatic activities was found in preparations in tablet form contrary to preparations in granulated form. A prerequisite for a successful therapy is enzymically potent pancreatic extracts with high enzyme content per table, capsule or recommended dose of granulated preparation. Therefore, some preparations seem to be preferable to others for clinical purposes.

Amylases↗
PubMed1979

Influence of anticholinergic treatment on rat pancreatic protein and amylase concentrations.

Pancreatic protein and amylase concentrations were measured after subcutaneous administration of an anticholinergic drug (Pro-Banthine to rats in different doses. In doses comparable to those given in acute pancreatitis an increase of both pancreatic protein and amylase concentrations was found. If pancreatitis is indeed caused or maintained by proteases released from the acinar cell, anticholinergics--giving rise to an accumulation of enzymes within the pancreas--may do more harm than good in the treatment of acute pancreatitis.

Acute Disease↗
PubMed1979

Trypsin as a regulator of pancreatic secretion in the rat.

The effect of intraduodenally administered trypsin on pancreatic exocrine secretion was investigated in conscious rats surgically prepared with bile--pancreatic fistulae. Introduction of NaHCO3 into the duodenum did not influence pancreatic secretion. Reintroduction of bile--pancreatic juice into the duodenum, however, suppressed pancreatic protein output, mainly because of changes in protein concentration. Infusion of trypsin into the duodenum in the absence of intraluminal pancreatic juice significantly suppressed the secretory volume and pancreatic enzyme output; addition of trypsin inhibitor to the trypsin infusion resulted in an immediate increase of pancreatic secretion. Trypsin inhibitor per se, however, was without effect. Bile--pancreatic juice affected amylase, kipase, and trypsinogen output in a parallel fashion; after addition of trypsin inhibitor to the infusion the inhibitory effects on pancreatic enzyme output was reversed in a parallel manner. The results support the hypothesis that pancreatic exocrine secretion is regulated by a feedback mechanism exerted--at least partly--by intraluminal trypsin.

Amylases↗
PubMed1979

Intestinal lysosomal enzymes in the diagnosis of pancreatic disease.

Acid hydrolases (lysosomal enzymes) were analyzed and compared with trypsin in duodenal juice obtained after a test meal (Lundh test). The possible diagnostic role of acid hydrolases in pancreatic disease was investigated. In all patients with chronic pancreatitis normal values of acid hydrolases but subnormal trypsin activities were found. In pancreatic cancer normal values of acid hydrolases and normal trypsin values were seen in three patients with small tumors, whereas five patients with more advanced cancer of the pancreas had decreased trypsin activity and three of them high activities of acid hydrolases in duodenal juice. In five patients operated on with a gastroenteroanastomosis acid hydrolases were markedly increased. Five patients had no activity of acid hydrolases in the aspirate, probably reflecting technical failure with dislodgement of the catheter from the duodenum to the stomach. In conclusion the assay of acid hydrolases does not seem to increase the diagnostic value of the conventional Lundh test (trypsin).

Acetylglucosaminidase↗