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Biomedical subjects

I Nordback

Publications and source records attributed to I Nordback.

At least 109 records · Page 6Linked to original sources
PubMed1980

Progesterone-dependent and -independent avidin production in chick oviduct organ culture.

Progesterone-dependent and -independent avidin inductions were found in chick oviduct culture. The effects of oestrogen priming and actinomycin D on these inductions were studied. Priming comprised daily diethylstilboestrol (DES) injections in vivo and one day's incubation in vitro with DES before experimental treatment. After 0 or 1 day of DES pretreatment no measurable amount of avidin was found. Avidin was present in progesterone-untreated incubated tissues after 4 days' DES pretreatment. Incubation with progesterone for 24 h increased avidin levels only after 4 or more days of oestrogen priming. No induction of avidin by actinomycin D similar to that found in vivo was observed in vitro. Actinomycin D inhibited both progesterone-dependent and -independent avidin production, but this effect diminished as oestrogen pretreatment was prolonged. Actinomycin D also significantly reduced total oviductal RNA synthesis. It is concluded that oestrogen priming enhances both progesterone-dependent and -independent avidin production in vitro and that both inductions are partially dependent on new RNA synthesis.

Animals↗
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Clinicopathologic and histochemical study of ovarian clear cell carcinoma.

Thirteen case reports of mesonephroid clear cell carcinoma of the ovary were analyzed and nine of the tumors were studied histochemically. No disorders were found in the hormonal balance of patients. The tumors produced few symptoms, indicating late discovery and bad prognosis. Histopathologically, the tumors were subdivided into the following groups: glandular, papillary, mixed-type and anaplastic. All of them contained glycogen and neutral mucins; acid mucins were found mainly in glandular tumors, which contained more sulfomucins than carboxymucins. Generally, the most active glandular tumors did not produce sialomucins. No clear correlations between prognosis and clinical pictures, morphology or constitution of cell excretions were found.

Adenocarcinoma↗
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Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis--a single-center randomized study.

Pancreatic infection is the main indication for surgery and the principal determinant of prognosis in acute necrotizing pancreatitis. Previous studies on the effects of antibiotics have not, however, uniformly demonstrated any reduction in the need for surgery or any decrease in mortality among these patients, although the incidence of pancreatic infections was significantly reduced. This single-center randomized study was designed to compare early vs. delayed imipenem treatment for acute necrotizing pancreatitis. Ninety patients with acute necrotizing pancreatitis (C-reactive protein > 150 mg/L, necrosis on CT) were randomized within 48 hours either to a group receiving imipenem (1.0 g plus cilastatin intravenously 3 times a day) or a control group. Not included were those who had been started on antibiotics at the referring clinic, those who were taken directly to the intensive care unit for multiorgan failure, and those who refused antibiotics or might have had adverse reactions. Thirty-two patients were excluded because they were over 70 years of age (not potentionally operable) or for any study violation. There were 25 patients in the imipenem group and 33 patients in the control group. The main end point was the indication for necrosectomy due to infection (i.e., after the initial increase and decrease, there was a second continuous increase in temperature, white blood cell count [> 30%] and C-reactive protein [> 30%], with other infections ruled out, or bacteria were found on Gram stain of the pancreatic fine-needle aspirate). In the control group, imipenem was started when the operative indication was fulfilled. Conservative treatment was continued for at least 5 days before necrosectomy. The study groups did not differ from each other with regard to sex distribution, patient age, etiology, C-reactive protein concentration, and extent of pancreatic necrosis on CT. Two (8%) of 25 patients in the imipenem group compared to 14 (42%) of 33 in the control group fulfilled the operative indications (P = 0.003). Nine patients in the control group responded to delayed antibiotics but five had to undergo surgery. Of those receiving antibiotics, 2 (8%) of 25 in the early antibiotic (imipenem) group needed surgery compared to 5 (36%) of 14 in the delayed antibiotic (control) group (P = 0.04). Two (8%) of 25 patients in the imipenem group and 5 (15%) of 13 patients in the control group died (P = NS [no significant difference]). Seven (28%) of 25 in the imipenem group and 25 (76%) of 33 in the control group had major organ complications (P = 0.0003). Based on the preceding criteria, early imipenem-cilastatin therapy appears to significantly reduce the need for surgery and the overall number of major organ complications in acute necrotizing pancreatitis, and reduces by half the mortality rate; this is not, however, statistically significant in a series of this size.

Adult↗
PubMedDate not supplied

Post-ERCP pancreatitis: reduction by routine antibiotics.

Cholangitis and pancreatitis are severe complications of endoscopic retrograde cholangiopancreatography (ERCP). Antibiotics have been considered important in preventing cholangitis, especially in those with jaundice. Some have suggested that bacteria may play a role in the induction of post-ERCP pancreatitis. It is not clear, however, whether the incidence of post-ERCP pancreatitis could be reduced by antibiotic prophylaxis, as is the case with septic complications. In this prospective study, a total of 321 consecutive patients were randomized to the following two groups: (1) a prophylaxis group (n = 161) that was given 2 g of cephtazidime intravenously 30 minutes before ERCP, and (2) a control group (n = 160) that received no antibiotics. All patients admitted to the hospital for ERCP who had not taken any antibiotics during the preceding week were included. Patients who were allergic to cephalosporins, patients with immune deficiency or any other condition requiring antibiotic prophylaxis, patients with clinical jaundice, and pregnant patients were excluded. In the final analysis six patients were excluded because of a diagnosis of bile duct obstruction but with unsuccessful biliary drainage that required immediate antibiotic treatment. The diagnosis of cholangitis was based on a rising fever, an increase in the C-reactive protein (CRP) level, and increases in leukocyte count and liver function values, which were associated with bacteremia in some. The diagnosis of acute pancreatitis was based on clinical findings, and increases in the serum amylase level (>900 IU/L), CRP level, and leukocyte count with no increase in liver chemical values. The control group had significantly more patients with post-ERCP pancreatitis (15 of 160 in the prophylaxis group vs. 4 of 155 in the control group; P = 0.009) and cholangitis (7 of 160 vs. 0 of 155; P = 0.009) compared to the prophylaxis group. Nine patients in the prophylaxis group (6%) and 15 patients in the control group (9%) had remarkably increased serum amylase levels (>900 IU/L) after ERCP, but clinical signs of acute pancreatitis with leukocytosis, CRP reaction, and pain developed in four of nine patients in the prophylaxis group compared to 15 of 15 patients with hyperamylasemia in the control group (P = 0.003). In a multivariate analysis, the lack of antibiotic prophylaxis (odds ratio 6.63, P = 0.03) and sphincterotomy (odds ratio 5.60, P = 0.05) were independent risk factors for the development of post-ERCP pancreatitis. We conclude that antibiotic prophylaxis effectively decreases the risk of pancreatitis, in addition to cholangitis after ERCP, and can thus be routinely recommended prior to ERCP. These results suggest that bacteria could play a role in the pathogenesis of post-ERCP pancreatitis

Acute Disease↗
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Effects on endogenous acetaldehyde production by disulfiram and ethanol feeding on rat pancreas.

Exogenous acetaldehyde infusion can induce pancreatitis-like injury of the pancreas in some isolated pancreas models, whereas in vivo such treatment has failed to induce pancreatitis. In vivo exogenous acetaldehyde may not be effective because it is rapidly metabolized. The aim of this study was to investigate whether endogenous acetaldehyde accumulates in the pancreas after ethanol feeding when acetaldehyde metabolism is blocked by disulfiram, and whether this treatment can induce pancreatitis-like injury in the rat. The liver was studied for comparison. In part I of the experiment, adult male Wistar rats were given water (n = 24), ethanol (n = 24), disulfiram (n = 24), and ethanol plus disulfiram for 1 week (n = 24) or 3 weeks (n = 24) and for 3 weeks with (n = 6) and without (n = 6) hypovolemia. In part II of the experiment, rats were given water (n = 6), ethanol (n = 6), and high-dose disulfiram (n = 6) and ethanol plus high-dose disulfiram (n = 6). Ethanol and acetaldehyde concentrations in blood, liver, and pancreas were measured. Animal behavior was monitored, and weight changes, plasma amylase activity, water content, and histomorphology of the pancreas and liver were studied without knowing the group. No increases in plasma amylase activity and no histomorphologic changes in the pancreas were observed under light or electron microscopy in part I of the experiment. In part II, treatment with ethanol induced acetaldehyde accumulation in the liver (33.6 +/- 2.6 micromol/L), but to a lesser degree in the blood (9.6 +/- micromol/L) and pancreas (5.0 +/-.2 micromol/L). Ethanol plus disulfiram induced marked accumulation of acetaldehyde in the liver (83.2 +/- 15.9 micromol/L), blood (280.0 +/- 47.4 micromol/L), and pancreas (43.6 +/- 4.7 micromol/L). When tissue acetaldehyde levels reached 30 to 40 micromol/L, we found a decrease in zymogen granules along with formation of small intracytoplasmic vacuolizations in the acinar cells and accumulation of lipid droplets in the hepatocytes, whereas physiologic signs of pancreatitis (hyperamylasemia, edema) or increases in liver enzymes did not develop. High levels of acetaldehyde accumulate in the liver and pancreas with the treatment described. Although this was accompanied by lipid degeneration of the hepatocytes and some subcellular changes in the acinar cells, physiologic signs of pancreatitis did not develop. Thus acetaldehyde accumulation alone, or in combination with hypovolemia, is not responsible for the induction of acute pancreatitis.

Acetaldehyde↗
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Effect of atropine on insulin secretion in healthy subjects.

The effect of an anti-cholinergic drug (atropine) on insulin secretion was studied in a double-blind manner by the glucagon C-peptide secretion test in five healthy subjects and controlled with saline only (placebo) in four subjects. Blood C-peptide increased only by 157% in the group given atropine and by 252% in the group given placebo. The blood glucose concentration increased by 25% and 32%, respectively. Thus, it is concluded that the cholinergic system, probably through the vagus nerve, has an insulin secretion stimulating effect. The results also suggest that denervation of the vagus nerve, e.g. in gastric surgery, may partly explain post-prandial hyperglycaemia particularly found in dumping.

Adult↗
PubMedDate not supplied

Association between common bile duct stones and treated hypothyroidism.

BACKGROUND/AIMS: The purpose of this study was to investigate the frequency of diagnosed hypothyroidism in patients with common bile duct stones. METHODOLOGY: The common bile duct stone group (Group I) consisted of all the patients who had verified gallstones in the common bile duct in endoscopic retrograde cholangiopancreatography during 1995. The control group (Group II) was matched for age, sex, and hospital admission. These patients did not have diagnosed gallbladder or common duct stones. In both groups there were 86 patients (56 women and 30 men). The median age in these groups was 73 (range: 22-92) years at the time of common bile duct stone diagnosis. Medical records of all patients were reviewed. RESULTS: In Group I the prevalence of previously diagnosed hypothyroidism was 7/86 (8%) compared with 1/86 (1%) in Group II (P = 0.01). Hypothyroidism was previously diagnosed only in the common bile duct stone patients (Group I) of over 60 years of age, where the prevalence was 7/66 (11%). In addition, we studied 36 consecutive gallbladder stone patients (Group III) of over 60 years, who had no evidence of common bile duct stones. Hypothyroidism had been diagnosed in them less frequently (2/36 = 6%) than in the age and hospital admission matched common bile duct stone patients (P = 0.01). Other diagnosed endocrine disorders did not differ between the study groups. CONCLUSIONS: There is a significant association between the common bile duct stones and previously diagnosed hypothyroidism. There stronger association between the common bile duct stones and hypothyroidism compared to gallbladder stones and hypothyroidism suggests a mechanism other than merely the cholesterol metabolism mediated mechanism. The 11% prevalence of previously diagnosed hypothyroidism in the common bile duct stone patients of over 60 years of age suggests all patients with common bile duct stones be screened for current thyroid dysfunction.

Adult↗
PubMedDate not supplied

Ultrasonography and computed tomography in the diagnosis of portomesenteric vein thrombosis.

This study was undertaken to evaluate ultrasonography (US) and computed tomography (CT) in the diagnostics of portomesenteric vein thrombosis (PMT). Between 1972-1988 we found 40 cases with PMT, all verified in angiography and/or autopsy. Between 1972-79 US and CT were never used, when 19 cases with PMT were found (1 premortem diagnosis with splenoportography). Between 1980-88 there were 21 patients with PMT. US was performed in 13, detecting PMT in 2. CT was performed in 5 patients confirming US diagnosis in 2 cases and revealing one further PMT. One PMT was diagnosed in the venous phase of an arteriography. The sensitivities of US and CT to detect PMT were 15% (2/13) and 60% (3/5) (p less than 0.05). The delay until diagnosis decreased from 27 +/- 28 days in 1972-79 to 12 +/- 9 days in 1980-88 (p less than 0.02). However, neither the rate of correct antemortem diagnosis (5% vs 19%) nor the survivals (68% vs 65%, 95% vs 81%, 95% vs 100% at 1, 12 and 60 months) were improved. Because only the patients with correct diagnosis received appropriate therapy, followed by longest survivals, the importance of the diagnostic attempts should not be questioned. CT may be more sensitive than US for detecting PMT, but neither method have yet replaced angiographic techniques.

Evaluation Studies as Topic↗
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Screening a family for hereditary chronic pancreatitis.

Chronic "idiopathic" pancreatitis (CP) in a 7 year-old-boy, whose father has suffered from CP, and whose former grandfather had suffered from pains possibly of pancreatic origin, led us suspect a hereditary etiology. An analysis, extended in a control fashion to the relatives of the healthy spouse of the affected grandfather, surprisingly revealed 2 more proven and 3 more suspected CP, giving the overall number of 8 affected members in this 35-member 3 generation kindred and revealed a maternal heredity instead of paternal heredity (which was first thought to be apparent). We therefore recommend that in a family suspected to suffer from hereditary CP (HCP), a screening should be extended to cover even the unaffected spouse's family--the present extended study revealed for 23 new members them to belong in an affected family. Without an extensive screening advises for family planning, alcohol consumption etc. can not be given. Plain abdominal X-ray accompanied with epigastric ultrasonographic are suitable for screening, which might be extended to every individual in smaller families, but may be safely restricted to the members ever suffered from epigastric pains in the case of a huge family. Pancreatic duct anomalies, hyperlipidaemia, hypercalcaemia, aminoaciduria or hyperimmunoglobulinaemia, all of which have been seen to accompany HCP, were not present in this family. Neither was any linkage found between the penetrance of HCP and ABO/Rh blood groups or HLA haplotypes.

Adolescent↗
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Peripancreatic vascular occlusions as a complication of pancreatitis.

In the case records of patients with a pancreatic inflammatory state (1,268 patients) during a 15-year period (1972-1986) we found 11 patients, who were diagnosed as having vascular obstruction in association with pancreatitis. The incidence was thus found to be 0.9%. This incidence was three times higher in chronic than in acute pancreatitis. Vessels near the head of the gland were the most frequently affected. Arteries predominated (64%). A laparotomy had been previously performed on seven patients. Thus manipulation of the pancreas may be an important co-factor in pathogenesis. Ten patients (91%) died. Only four (36%) were correctly diagnosed before autopsy. The diagnostics and clinical implications of various forms of vascular occlusions with pancreatitis are discussed.

Acute Disease↗
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Pancreatic remnant abscess after resection for acute necrotising pancreatitis.

Pancreatic resection for acute necrotising pancreatitis was followed by abscess of the remnant in 14 out of 83 cases. Not even extensive pancreatic resection could prevent pancreatic remnant infection. The 14 cases of abscess are reviewed. Seven were fatal. Enterocutaneous fistula, commonly accompanied by sepsis and major bleeding, was identified in five patients, four of whom died.

Abscess↗
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Ranson signs and necrosis of the pancreas in acute necrotising pancreatitis.

The value of Ranson signs as an indicator of the extent of pancreatic parenchymal necrosis in acute pancreatitis was investigated in 84 patients. Ranson signs could be compared with histologic extent of pancreatic necrosis in 69 cases. The overall mortality rate was 38/84 (45%). The mortality risk increased with the number of positive Ranson signs (correlation coefficient 0.96). The mean total of Ranson signs showed linear increase with extent of parenchymal necrosis up to 75% (from 2.9 signs at no necrosis to 5.4 signs at 75% necrosis, but only 4.7 signs at 76-100%). A similar relationship was found between extent of necrosis and mortality rate. Although the number of positive Ranson signs correlated with the extent of necrosis in resected pancreas (coefficient 0.96), the signs did not adequately predict necrosis in total pancreas. Ranson criteria can be accepted as prognostic signs even when acute necrotizing pancreatitis is treated with resection. The Ranson factors also correlate with necrosis, but do not alone reliably establish its extent in individual cases.

Acute Disease↗
PubMedDate not supplied

Changing strategies in the surgical management of acute necrotizing pancreatitis.

During 1982-90 we changed the surgical treatment of acute necrotizing pancreatitis twice. The operative strategy consisted of early formal resection (n = 13) during 1982-84, early lavational surgery (n = 15) during 1985-87 and late necrosectomy (n = 17) during 1988-90. The mortality rate decreased from 54% to 40% and to 24%, respectively. The pattern of complications changed from bleeding in resections to pseudocysts and fistulas in late necrosectomy. Sepsis and multiorgan failure were still main problems. These results led us to begin a prospective study of planned repeated debridement by open packing after delayed necrosectomy.

Acute Disease↗
PubMedDate not supplied

Twenty to thirty year follow-up after cholecystectomy.

BACKGROUND/AIMS: We studied retrospectively the need for re-examinations and re-operations, the development of alimentary tract cancer, and the occurrence of abdominal symptoms 20-30 years after elective cholecystectomy. MATERIAL AND METHODS: Between 1963 and 1973 296 patients (73 males and 223 females) were treated by cholecystectomy. The indication was biliary colics plus stones in gallbladder. Patients with biliary-enterostomy, sphincteroplasty or synchronous extrabiliary operations were excluded. Retained bile duct stones were excluded by cholangiography. Medical records of all patients, death certificates of the patients who had died during the follow-up (n = 74), and the autopsy findings of autopsied patients (n = 29) were reviewed. The living 220 patients were interviewed by a structured questionnaire a median of 26 years after the operation. RESULTS: Patients were divided into two groups: Group I (172 patients) underwent cholecystectomy only and Group II (122 patients) underwent cholecystectomy and common duct stone extraction. During the follow-up, 25 patients (9%) underwent examinations for biliary colics and 12 (4%) were re-operated, 10 during 1-5 years after cholecystectomy. Both the examinations and re-operations were more common in Group II than in Group I (p < 0.005). Eight patients developed alimentary tract cancer during the follow-up. Thirty-nine per cent of patients reported abdominal symptoms, 20% having had these already prior to cholecystectomy. Abdominal pain was reported by 21%, distention by 20%, heart burn 16%, obstipation 14%, and diarrhea by 11%. Abdominal pain and diarrhea occurred more frequently in Group I than in Group II. CONCLUSION: Recurrent biliary colics and stones in the common bile duct are extremely rare later than five years after cholecystectomy and are not expected unless the patients have also initially had common duct stones. One third of patients suffer from other abdominal symptoms.

Case-Control Studies↗
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The value of the endoscopic pancreatogram in peritoneal or pleural pancreatic fistula.

Endoscopic retrograde pancreatogram (ERP) has been recommended in patients with suspected pancreatic fistula to visualize the fistula tract and the ductal anatomy. Recently we have treated five men with chronic alcoholic pancreatitis complicated by pancreaticopleural or pancreaticoperitoneal fistula. The limited value of ERP in these patients is described. Computed tomography (CT) demonstrated dilated pancreatic duct (3 patients) or a pseudocyst (2 patients). A fistula tract protruding into the chest was detected by CT in two patients. In ERP the two pseudocysts could not be visualized. In none of the five patients could the fistula tract be visualized. Instead, the main pancreatic duct was completely occluded in the head of the pancreas in all five patients. The drainage of the pancreatic juice into the intestine was secured surgically by a jejunal Roux-Y loop connected to the pancreatic duct opened from the tail to the most proximal ERP demonstrated stricture (Puestow-type operation, 4 patients) or to the leaking pseudocyst (1 patient). During the follow-up of 3-24 months pleural or peritoneal effusions have not recurred. The role of ERP in a patient with a pancreatic fistula into the pleural or peritoneal cavity is to localize the site of the duct obstruction, whereas the demonstration of the distal duct anatomy or the fistula tract are of less importance.

Adult↗