PubMed Health⌕ Search

Biomedical subjects

J Ekengren

Publications and source records attributed to J Ekengren.

14 recordsLinked to original sources
PubMed1998

Operative course of transurethral resection of the prostate and progression of prostate cancer.

Surgery has the potential to disseminate cancer cells, and we therefore hypothesized that extensive transurethral resections of the prostate (TURP) would be followed by a worse prognosis than minor ones. For this purpose, the association between the extent of surgery, disease progression, and mortality was studied in 138 patients with prostatic cancer who had undergone TURP. The results show that a large bleed (> or = 275 ml) indicated a slightly increased relative risk of general progression of the cancer (relative risk (RR) = 1.9, 95% confidence interval (CI) = 0.9-4.1) and death (RR = 1.5, CI = 0.6-3.3). Other parameters of extensive surgery, such as the operating time and fluid absorption, were not associated with increased risk. Patients with a medical disease, however, such as hypertension and congestive heart failure, had a significantly higher relative risk of general progression (RR = 2.7, CI = 1.2-6.1) and death from prostatic cancer (RR = 4.6, CI = 2.0-10.7) in addition to an increased relative risk of death from other causes (RR = 3.7, CI = 1.3-10.5). We conclude that concurrent medical disease, but not an extensive TURP, worsened the prognosis of patients with prostatic cancer who underwent TURP.

Adenocarcinoma↗
PubMed1997

Free and total prostate-specific antigen serum concentrations do not help to detect prostate cancer in patients with urinary outlet obstruction.

OBJECTIVES: To determine whether different molecular forms of prostate-specific antigen (PSA) obtained before transurethral resection of the prostate (TURP) indicate the presence of prostate cancer. PATIENTS AND METHODS: The free, total and free-to-total PSA levels were measured in 261 patients scheduled for TURP, 20 of whom had known prostate cancer. The tissue histology was compared with the PSA levels and the patients were followed for 5 years. RESULTS: Prostate cancer was detected in 23 of the patients (9%) who were thought to have benign disease. Normal ranges for the distribution of the PSA levels were established based on the patients with a benign histology, but these ranges did not detect most of the unknown cancers. The sensitivity of the total PSA test in detecting cancer was 38% and the specificity 90%. The discrimination was no better when considering the free fraction or the free-to-total PSA level. However, none of the 14 patients whose cancer was missed showed general progression of the disease during the 5-year follow-up and only one died from prostate cancer. In contrast, eight of the 20 patients with a known prostatic malignancy showed general progression, and six died from the disease. CONCLUSION: PSA testing of patients with outlet obstruction often failed to detect prostate cancer, but the prognosis was moderately good in those patients in whom it was missed.

Adult↗
PubMed1996

Complications during transurethral vaporization of the prostate.

OBJECTIVES: To review adverse events during transurethral vaporization of the prostate (TVP) and to compare them with those occurring during transurethral resection of the prostate (TURP). METHODS: One experienced surgeon performed 26 consecutive TVPs and 100 TURPs. We monitored blood loss by photometry, fluid absorption by the ethanol method, and hemodynamic stability with a blood pressure manometer. RESULTS: Total blood loss and the rate of blood loss were significantly lower during TVP. Fluid absorption occurred during most TVPs, but it was mostly small volumes. No sudden drop in arterial pressure was recorded during TVP, but this did occur in 11% of the TURPs. Complications that would normally require medical attention (blood loss greater than 800 mL, fluid absorption greater than 500 mL, or hemodynamic instability) were more infrequent during TVP than during TURP (P = 0.012). CONCLUSIONS: Transurethral vaporization of the prostate was associated with fewer intraoperative complications than was TURP.

Aged↗
PubMed1996

Femoral vein blood flow during transurethral resection of the prostate.

OBJECTIVE: To determine whether bladder distension affects venous haemodynamics during transurethral resection of the prostate (TURP) such that irrigating fluid is more easily absorbed. PATIENTS AND METHODS: The right common femoral vein was examined using an ultrasound Doppler blood-flow scanner in 10 patients (mean age 73 years, range 63-80) undergoing TURP. Measurements of blood flow were performed before, during and after the bladder was filled with irrigating solution. Fluid absorption was measured by the ethanol method. RESULTS: Measurements before, half-way through and immediately after the resection all showed that the luminal diameter and the cross-sectional area of the femoral vein increased significantly when the bladder was filled with irrigating fluid. Furthermore, a decrease in the normal variation of blood flow with breathing often occurred when the bladder was filled, indicating that proximal venous obstruction was the cause of the increase in vessel diameter. However, there was no apparent association between these changes and the absorption of irrigating fluid. CONCLUSIONS: Filling the bladder with irrigating fluid with the patient in the lithotomy position during TURP was followed by signs of iliac venous obstruction but this did not correlate with the absorption of irrigating fluid.

Aged↗
PubMed1996

Operative factors and the long-term incidence of acute myocardial infarction after transurethral resection of the prostate.

We studied the association between the operative course of transurethral resection of the prostate (TURP) and the morbidity of acute myocardial infarction (AMI) in a cohort comprising 846 patients who underwent this operation between 1983 and 1992. Up to the end of 1993, a total of 69 patients had developed AMI, of which 10 patients had a reinfarction. The relative risk associated with absorption of 500 ml or more of the irrigating medium during surgery was 1.6 [95% confidence interval (CI) = 0.9-3.0] for a first-time AMI after TURP, 6.1 (95% CI = 1.8-20.7) for a reinfarction, and 2.2 (95% CI = 1.3-3.9) for a first-time or a reinfarction combined. A blood loss of 275 ml or more was associated with a decreased relative risk (RR = 0.4; 95% CI = 0.2-0.8) of a first-time AMI after TURP. Patients who lost less than 275 ml of blood and absorbed 500 ml or more of irrigating fluid during surgery had 4.4 times the risk of having an acute myocardial infarction (RR = 4.4; 95% CI = 1.7-11.8). These results appear to indicate that the operative course of TURP is important to the development of AMI over an extended period of time.

Aged↗
PubMed1996

Large-sized bladders reduce intravesical pressure and fluid absorption during TURP using the suprapubic trocar.

We studied whether the height of the irrigating fluid bags above the operating table and the capacity of the bladder influence intravesical pressure and fluid absorption during transurethral resection of the prostate (TURP) when evacuation is performed with Reuter's trocar. For this purpose, the intravesical pressure was recorded continuously, and the fluid absorption was measured by the ethanol method during 30 TURP procedures. The bags were placed between 60 and 95 cm above the operating table, and the bladder capacity was measured before surgery started. The results show that the bladder capacity, but not the bag height, correlated with the intravesical pressure and the fluid absorption. Large-sized bladders were associated with lower pressures and smaller absorption. Rapid absorption (>30 ml/min) occurred at a maximum pressure of 2-3 kPa and a mean pressure of between 1 and 2 kPa. In conclusion, the size of the bladder is important to the intravesical pressure and to the fluid absorption during TURP when using the suprapubic trocar.

Absorption↗
PubMed1995

Effects of bladder capacity and height of fluid bag on intravesical pressure during transurethral resection of the prostate.

We studied the intravesical pressure profile and the fluid absorption in 30 men undergoing transurethral resection of the prostate with the irrigating fluid bags placed 55-60, 70-75, 80-85 or 90-100 cm above the operating table. The maximum intravesical pressure, but not the mean pressure or the period of time during which there was excessive pressure (> 2 kPa), increased when the fluid bags were placed higher. The urologist consistently reached about half the possible maximum pressure as indicated by the bag height at the end of each intermittent filling of the bladder. A large bladder capacity promoted lower maximum and mean pressures and shortened the period of excessive intravesical pressure. However, neither bag height nor bladder capacity correlated with the absorption of irrigating fluid.

Absorption↗
PubMed1995

Fluid absorption during transurethral bladder surgery.

We report 2 patients who absorbed large amounts of irrigating fluid during transurethral resection of bladder tumours (TURB). Ethanol indication facilitated diagnosis of this complication and showed that absorption had occurred by the extravascular route. Symptoms occurred in one case but they resolved when hypertonic saline and furosemide were given.

Aged↗
PubMed1994

Continuous versus intermittent flow irrigation in transurethral resection of the prostate.

OBJECTIVE: We compared fluid absorption, blood loss, and immediate postoperative complications in transurethral resection of the prostate (TURP) performed with the continuous flow and the intermittent flow irrigation techniques. We also studied pressure conditions under which fluid absorption occurs when continuous flow irrigation is used. METHODS: One experienced urologic surgeon performed TURP in 40 patients using suprapubic drainage of the bladder and in 40 other patients using the intermittent-filling technique. Fluid absorption was measured by the ethanol method every ten minutes. The intravesical pressure was recorded continuously in 23 of the patients with suprapubic drainage. RESULTS: Fluid absorption was more common when suprapubic drainage was used (P < 0.004). There were no differences in operating time, blood loss, postoperative complications, or in the period of hospitalization. Low-degree absorption occurred during minor elevations of the intravesical pressure, and massive fluid absorption was associated with pressures between 1.0 and 2.5 kPa (10 and 25 cm H2O). CONCLUSIONS: Continuous flow irrigation promoted fluid absorption, which occurred at lower pressures than commonly believed. With respect to other parameters, we found no superiority of one irrigating technique over the other.

Absorption↗
PubMed1993

Absorption of irrigating fluid and height of fluid bag during transurethral resection of the prostate.

The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60-65, 70-75, 80-85 or 90-100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analyzed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.

Absorption↗
PubMed1993

Blood loss during transurethral resection of the prostate as measured by the HemoCue photometer.

Blood loss was measured with the portable HemoCue photometer and the absorption of irrigating fluid was assessed by the ethanol method during 700 transurethral resections of the prostate. The blood loss ranged between 10 and 3,825 ml (median 300 ml). The weight of the resected prostatic tissue and the operating time were independent predictors of the amount of blood lost. General anaesthesia (n = 82) and malignant histology (n = 114) were associated with a smaller blood loss. In the patients who were given regional anaesthesia (n = 618), an mean systolic blood pressure of 100 mmHg or less resulted in a smaller bleed. Large-scale irrigating fluid absorption was typically associated with a blood loss of medium size and ranged between 500 and 1,000 ml. The incidence of such absorption was negligible in the patients in whom the blood loss per gram of resectate was less than 10 ml/g. Blood loss was also measured every 10 min during the course of another 110 operations, from which 20 patients with operating times in excess of 60 min were selected. Our analysis showed that no excessive blood loss occurred after 60 min of surgery.

Absorption↗
PubMed1991

Effects of 1.5% glycine solution with and without 1% ethanol on the fluid balance in elderly men.

Ten male patients scheduled for transurethral prostatic resection (aged 57-79) were given irrigating fluid by intravenous infusion at 50 ml.min-1 over 20 min. Each patient was subjected to two infusions: 1.5% glycine in water on one occasion, and the same solution but with 1% ethanol added on the other. Urine and blood samples were collected at regular intervals for up to 2 h after infusion, and the changes in the distribution of water and electrolytes between fluid compartments were calculated. Transient prickling skin sensations were frequently reported effects of the infusions. Two patients experienced visual disturbances. There were no changes in the blood ammonia and plasma vasopressin levels. During the infusions, the estimated blood volume and the total plasma sodium and potassium content increased. The solutions produced osmotic diuresis with increased urinary excretion of water and electrolytes. After ending the fluid administration, blood volume was rapidly restored. Over the following 120 min the irrigant water was redistributed intracellularly or removed by urinary excretion. The addition of ethanol did not alter the overall effects of glycine solution on the fluid balance.

Absorption↗
PubMed1978

Acute arterial occlusion.

During the years 1969--1976, 66 patients were subjected to surgery for acute arterial occlusion. Arterial occlusion was due to emboli in 67% of the patients, and to acute thrombosis in 33%. There was no difference in the mean age for the two groups. More than 50% of the occlusions, embolic as well as thrombotic, were located in the femoral artery. In the embolic group limb salvage rate was 93% and patient survival rate 82%. The corresponding figures for the thrombotic group were both 73%. There was no direct correlation between the number of amputations and the time interval from occlusion to operation in either of the two groups. In the embolic group, adequate backflow was reestablished in 82%, while the corresponding figure in the thrombotic group was only 45%.

Acute Disease↗