Biomedical subjects

I Nordback

Publications and source records attributed to I Nordback.

At least 73 records · Page 4Linked to original sources

PubMed1992

Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy.

This prospective study consisted of 32 patients. In each patient, bile was collected during two separate endoscopic retrograde cholangiopancreatographies (ERCP) to study changes in biliary bacteriology and cytology. The mean interval between ERCPs was 20 months (15-29 months). Twenty-three patients had gallstones in the gallbladder, bile ducts, or both. Nineteen of them had bactibilia compared to none of the 9 patients with normal ERCP (P less than 0.001). Fifteen patients had normal bile ducts in ERCP (Group 1). Four of these patients (27%) had bactibilia initially and 9 (60%) at follow-up (P = 0.069). Seventeen patients had bile duct stones and underwent endoscopic sphincterotomy (Group II). Fifteen of these patients (88%) had bactibilia initially, and 15 (88%) also had bactibilia at follow-up. Initially, anaerobic bacteria were detected in 37 per cent of Group I patients with bactibilia and in 50 per cent of Group II patients with bactibilia. At follow-up, the bile in Group I patients infrequently (11%) contained anaerobes, whereas in Group II patients anaerobes predominated (67%; P less than 0.011). Clear correlation between the biliary cytology and bacteriology could not be observed. The authors conclude that ERCP may result in increased incidence of long-term bactibilia and suggest that contamination occurred during ERCP. The bactibilia associated with bile duct stones does not subside after endoscopic treatment of the common duct stones.

Adult↗

PubMed1991

Immediate effect of vagotomy on pancreatic insulin secretion.

The effect of vagotomy and gastric resection on insulin secretion was examined by the glucagon stimulated C-peptide test in gastrectomy patients (n = 11) without truncal vagotomy and in total gastrectomy patients (n = 10) with truncal vagotomy. The test was performed twice in each patient: 10 minutes after the midline incision was made and then 60 to 90 minutes later when gastric resection or total gastrectomy was completed, during the reconstructive phase of the operation. Gastric resection without truncal vagotomy was followed by a higher increase (48%) in serum C-peptide concentration caused by glucagon stimulation than total gastrectomy with truncal vagotomy (13%). There was a significant (p less than 0.05) increase in the glucagon stimulated glucose-related C-peptide concentration in patients without truncal vagotomy, whereas truncal vagotomy inhibited this increase. These results suggest that truncal vagotomy will produce a reduction in stimulated insulin secretion in humans.

Adult↗

PubMed1991

Postprandial blood concentrations of insulin-independent carbohydrate, galactose, in oral test after gastric surgery.

In order to examine the postprandial blood concentrations of insulin-independent carbohydrates after gastric surgery oral galactose test (1.65 g/kg body weight in water, 33%, w/v) was performed in 55 symptomatic patients and in 5 healthy subjects. There were patients after total gastrectomy (TG) (n = 17), gastric resection with (GRS, n = 17) or without (GR; n = 12) selective vagotomy, and after proximal selective vagotomy (PSV, n = 9). The patients had immediately after drinking the test solution a 2- to 5-fold higher blood galactose concentration than the healthy subjects. The TG patients had the most rapid, the healthy subjects the slowest and the GR and GRS patients an intermediate rapid, immediate increase of blood galactose concentration. The TG patients showed a plateau 40-60 min and a decrease 60-90 min after the start of the test. The PSV patients showed a plateau 60-90 min after the commencement of the test. The GR and GRS patients and the healthy subjects had a continuous increase in blood galactose concentration during the whole test period, but the maximal point 90 min after the drinking of the solution was lower in the GRS than in the GR patients and lowest in the healthy subjects. The PSV patients had a lower blood galactose curve than the TG, GRS and GR patients but higher than the healthy subjects except the plateau 60-90 min postprandially.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbohydrate Metabolism↗

PubMed1991

Prognostic value of analysis of DNA in pancreatic adenocarcinoma by flow cytometry.

DNA was analysed by flow cytometry in paraffin-embedded tumour specimens from 58 patients who had undergone resection of pancreatic ductal adenocarcinoma, to see if there was any correlation between DNA analysis and survival. Because of the poor quality of the DNA histogram five cases were excluded from the analysis of DNA-ploidy and 10 from the analysis of the synthesis phase fraction. Aneuploidy was detected in 11 (21%) of the 53 tumours. Neither aneuploidy nor synthesis phase fraction correlated significantly with size, stage or differentiation of the tumours. The survival of the patients with DNA-aneuploid tumours (median 9 months) did not differ significantly from that of the patients with diploid tumours (median 14 months). Four patients survived for 5 years or longer, two of whom had aneuploid tumours. Synthesis phase fraction did not correlate with survival. Using univariate survival analyses, location of the tumour in the head of the pancreas (p = 0.02), a tumour diameter of less than 3.8 cm (p = 0.003), tumour stages I and II (p = 0.03), and a well differentiated tumour (p = 0.04) correlated with favourable survival. In a Cox's regression analysis, however, only the diameter of the tumour had independent prognostic value. We conclude that DNA analysis by flow cytometry is not helpful in selecting patients with resectable pancreatic carcinoma who will benefit from resection.

Adenocarcinoma↗

PubMed1991

Improved detection of cancer of the body or tail of the pancreas.

Ultrasonography (US), computed axial tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) have not improved detection or prognosis of carcinoma of the pancreatic head. We investigated the influence of these imaging techniques on detection, and consequently prognosis of carcinoma of the pancreatic body or tail, where the symptoms are less specific (seldom jaundice or vomiting) and imaging techniques may be more important. Of 139 patients, 29 were treated in 1972-1977, when US, CT and ERCP were not used, 27 in 1978-1980, when US was occasionally performed, and 83 in 1981-1989, when all three methods were common. In 1978-1980 and 1980-1981 correct ante-mortem diagnosis was more common than in 1972-1977, and the diameter and stage of tumour were significantly reduced at laparotomy. The resectability rate was not increased, however, and the incidence of exploratory laparotomy was not reduced. The survival time in the last study period was significantly longer only in the non-operatively treated patients. The reason was not earlier diagnosis, but possibly better general management.

Adenocarcinoma↗

PubMed1990

Effect of ultraviolet therapy on rat skin wound healing.

Ultraviolet (UV) light therapy has been suggested as a treatment for pressure sores and crural ulcerations even though controlled trials are few. Therefore, the effect of UV light therapy on wound healing was studied in rat skin. A dose-dependent, significant improvement in the diminution of wound size was found between 4 and 15 days in wounds treated with UV as compared with untreated control wounds in the opposite side of the same animals. Wound closure, however, did not occur earlier in the treated wounds. UV had a marked warming effect; warmth alone without UV had no effect on wound healing. No significant difference was found in the tensile strength of UV-treated wounds at 7 and 15 days when compared with untreated wounds. Moreover, the intensity of the inflammation was equal in both treated and control wounds when studied histologically. We did not find any effect on clinical infection rate or bacterial colonization of the wounds. Although UV therapy seems to have an effect on wound healing in rat skin the present results are rather nonsupportive of the clinical benefits that are expected from this kind of treatment.

Animals↗

PubMed1990

Resectable leiomyosarcoma of inferior vena cava presenting as carcinoma of the pancreas. Case report.

A 61-year-old woman was thought to have a cancer of the head of pancreas on ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography (ERCP). At laparotomy, however, the pancreas was normal, and the tumour originated in the inferior vena cava. Histological examination showed a moderately differentiated leiomyosarcoma. The outcome was uneventful after caval resection and reconstruction with a polytetrafluoroethylene (Goretex) patch.

Diagnosis, Differential↗

PubMed1989

High volume lesser sac lavage in acute necrotizing pancreatitis.

The effect of lesser sac drainage with or without lavage on some early predictors and on outcome in acute necrotizing pancreatitis was analysed. The evaluation was made prospectively for 24 patients, in a single centre study. According to Ranson's criteria and laparotomy findings, the lavage and drainage groups were comparable and the pancreatitis was severe and necrotizing in both groups. In a longitudinal analysis of the first 4 postoperative days, lavage did not show any advantage over drainage, as measured by seven prognostic signs (serum creatinine, blood glucose, base excess, haematocrit, white blood cells, C-reactive protein and immunoreactive phospholipase A2 concentration). Furthermore, the study did not find that lavage had any positive effect on the incidence of mortality (36 versus 17 per cent in the drainage group) or on septic complications in acute necrotizing pancreatitis. In the total series the extent of pancreatic necrosis was an essential predictor of the outcome.

Acute Disease↗

PubMed1989

Human pancreatic phospholipase A2 in acute necrotizing pancreatitis.

The activity and the content of phospholipase A2 (PLA2), a potential 'toxin' in pancreatitis, were determined separately by respective methods in pancreatic tissue resected from 22 patients treated for acute necrotizing pancreatitis. Correspondent enzyme assays were analyzed in the serum of 6 last patients. In cases with total necrosis in the tissue resected, the pancreatic PLA2 activity, but not the content, was almost totally lost. Serum PLA2 activity slightly decreased within the extension of pancreatic necrosis. The timing of sampling, number of positive Ranson signs or the course of the disease had no influence on the tissue PLA2 results. Serum PLA2 activity showed a correlation with tissue PLA2 activity.

Acute Disease↗

PubMed1989

Management of unextractable bile duct stones by endoscopic stenting.

Active treatment of common bile duct stones is preferred because life-threatening complications such as suppurative cholangitis or pancreatitis may occur. In patients unfit for surgery endoscopic extraction of the stones is an excellent alternative. In cases with overwhelming difficulties in stone removal, permanent endoscopic biliary stenting gives good results even in the long-term follow-up. In a material consisting 104 patients, collected from own experiences and from the literature, and followed for 3-59 months, no patients developed acute pancreatitis. Seventeen per cent of patients experienced jaundice and 3% (17% of jaundiced) acute cholangitis. These complications could be easily managed with antibiotics and with the exchange of the stent. In only 2% of patients biliary surgery became obligatory.

Aged↗

PubMed1989

Surgery for reflux stricture of the oesophagus.

Reflux stricture of the oesophagus was surgically treated in 27 patients. Oesophageal resection and colon interposition were performed in 18 cases, and peroperative fiberoptic endoscopic dilatation with Nissen fundoplication in nine. There was one perioperative death (resection group). Postoperative complications arose in four of that group and one of the dilatation-fundoplication group. At follow-up averaging 86 months after resection and colon interposition, no patient was dysphagic; 44% experienced regurgitation, but most could avoid this by modifying living habits. Further dilatations were required by four of nine patients during follow-up averaging 30 months after dilatation-fundoplication. Fiberoptic endoscopic dilatation with fundoplication is well tolerated by fitter patients with reflux stricture of the oesophagus. In poor-risk patients the treatment should be dilatation and medical antireflux control. Due to higher complication rates oesophageal resection and colon interposition are warranted when other treatment has failed.

Adolescent↗

PubMed1988

Influence of pancreatic resection on systemic complications in acute necrotizing pancreatitis.

The influence of pancreatic resection on early systemic complications of acute necrotizing pancreatitis was evaluated in 84 patients. The aetiology of pancreatitis was alcohol 71 per cent, gallstones 13 per cent, alcohol plus gallstones 2 per cent, trauma 1 per cent and idiopathic 12 per cent. A total of 26 of 81 patients (32 percent) had greater than 50 per cent pancreatic necrosis and 9 patients (11 per cent) considered to have parenchymal necrosis at operation had none shown histologically. The overall mortality was 38/84 (45 per cent) and mortality during the first postoperative week was 15/84 (18 per cent). The outcome after early and delayed operation did not differ significantly. Pancreatic resection had no beneficial effect on shock or respiratory or renal failure (respective pre-operative incidence 12 per cent, 11 per cent and 14 per cent).

Acute Disease↗

PubMed1988

ERCP in evaluating the mode of therapy in pancreatic pseudocyst.

Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stenosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage.

Adult↗

PubMed1988

Post-ERCP acute necrotizing pancreatitis.

An analysis of acute necrotizing pancreatitis (ANP) after endoscopic retrograde cholangiopancreatography (ERCP) was carried out. The incidence of ANP was 0.5% (5/914) for ERCP and 0.5% (2/370) for endoscopic sphincterotomies (EST). All the five patients were obese, middle-aged or older women. Four had a suspicion of common bile duct stones and the fifth a pancreatic tumour as an indication for ERCP. Two had most probably a functional sphincteric disorder and the third was without clear pathological findings. In the remaining two cases the bile duct cannulation failed and repeated pancreatic duct cannulation occurred; while in one case the pancreatic duct was not cannulated. The four pancreatographies were normal and without parenchymal opacification. Symptoms of acute pancreatitis started within 6 hours after ERCP. The pancreatitis was severe by Ranson criteria and necrotizing by evaluation at laparotomy. All the patients showed bacterial growth either in bile, blood or ascitic fluid early in the course of pancreatitis (E. coli, Str. faecalis or Klebsiella pneumoniae). The possible pathogenetic factors of post-ERCP ANP are discussed.

Abscess↗

PubMed1988

Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy (EST) after BII resection.

We analysed the results of 437 endoscopic retrograde cholangiopancreatographies (ERCP) and 126 endoscopic sphincterotomies (EST) after gastric diversion surgery collected from the literature and from our hospital. The most difficult step in the procedure was duodenal intubation (90% success; range 33-95%). This greatly depended on the method of intestinal reconstruction. Poorest results were related to a long jejunal loop with entero-enterostomy (Braun's anastomosis). A final ERCP success rate was 74% (46-95%). EST could be performed in most of the cases (93%) indicated. Extraction of biliary calculi succeeded only infrequently. Insertion of biliary stents was possible. Special techniques of the procedure are discussed. It is concluded that ERCP and EST may also be performed after gastric surgery with varying success depending on the method of intestinal reconstruction. Both doctor and patient should be prepared to the possible use of alternative methods.

Aged↗

PubMed1988

C-reactive protein (CRP) and pancreatic necrosis in acute necrotising pancreatitis.

C-reactive protein (CRP) was measured on the operation day in 35 patients with acute necrotising pancreatitis. In this prospective study the CRP level differentiated with high significance (p less than 0.001) the patients with extensive pancreatic necrosis from the patients with limited pancreatic necrosis. A marked variation in CRP production was demonstrated in both groups. Therefore in individual cases CRP alone is not a reliable predictor of pancreatic necrosis.

Acute Disease↗

PubMed1988

Inflammation parameters in the diagnosis of acute appendicitis.

The role of the common parameters of inflammation in the diagnosis of acute appendicitis was studied by measuring axillary temperature (Tax), blood leukocyte (Leuk) and lymphocyte fraction (Lymph), serum C-reactive protein (CRP) and ESR in 354 patients with clinical diagnosis of acute appendicitis. Laparotomy showed normal appendix in 97 cases, but deduction of 14 with other surgically correctable disorders gave the negative appendectomy rate 83/354 (23.4%). The appendix had perforated in 9.9%. Tax, Leuk, Lymph and CRP could significantly differentiate acute appendicitis from the other cases, with respective sensitivity (and false positive) percentages 88.7 (66.0), 78.5 (24.7), 84.4 (48.5) and 52.7 (24.7). Although such statistical differences are not particularly helpful in preoperative diagnosis of individual cases, none of the 37 patients with simultaneously normal Leuk, Lymph and CRP had obvious appendicitis (2 probably had incipient inflammation). If laparotomy had not been performed in these 37 cases, almost half of the unnecessary operations could have been avoided, thereby reducing the negative appendectomy rate to 15.2%, with 11.7% perforation rate.

Abdomen, Acute↗

PubMed1987

Antifibrinolytic therapy for prevention of hemorrhage during surgery of the thyroid gland.

The amount of fibrinolytic activity in the thyroid gland equals that of the prostate. In order to examine the effect of the antifibrinolytic drug tranexemic acid on perioperative bleeding saline or tranexemic acid were given randomized double blind to 76 consecutive patients who came for scheduled thyroid surgery. No significant differences were found in perioperative bleeding between patients in the treatment group (n = 39) and control group (n = 37).

Adenoma↗