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Biomedical subjects

J L Hedenbro

Publications and source records attributed to J L Hedenbro.

At least 19 recordsLinked to original sources
PubMed2002

Fully stapled gastric bypass with isolated pouch and terminal anastomosis: 1-3 year results.

BACKGROUND: Roux-en-Y gastric bypass is a bariatric procedure of choice. There is evidence supporting a small isolated pouch and a wide anastomosis. Gastric vascular anatomy renders the ventral aspect less suited for anastomotic construction. The lesser curvature has abundant blood supply that should preferably not be interfered with. Terminal anastomosis is a logical choice. METHODS: We devised a way of making a fully stapled gastric bypass with complete separation of a pouch that empties dependently. The technique obviates the oral passage of the stapler anvil. Such a procedure facilitates the creation of an "end-of-pouch to end-of-jejunal limb" wide-diameter anastomosis and precludes the risk of staple-line disruption. RESULTS: Since October 1997 we have performed 227 such anastomoses (146 primary, 81 reoperative procedures) in consecutive patients with no leaks, no gastro-gastric fistulas and no mortality. The postoperative hospital time was 3.6 (3-8) days (median, range). In primary operations baseline BMI was 47.5, 1-yr 29.7 and 3-yr 29.2. Corresponding values for reoperations were 39.3, 30.8 and 31.5. Weight loss was adequate, and complications were limited to three anastomotic ulcers and two narrow stomas without visible ulcers but necessitating endoscopic dilatation. CONCLUSION: The technique confers distinctive advantages.

Adult↗
PubMed1997

Quality of life after gastroplasty is normal: a controlled study.

OBJECTIVE: To assess the quality of life of patients 1 1/2-5 1/2 years after vertical banded gastroplasty for morbid obesity. DESIGN: Retrospective study by questionnaire. SETTING: University hospital, Sweden. SUBJECTS: 102 of the 127 patients (80%) operated on for morbid obesity between January 1989 and February 1993 responded to the questionnaire. 74 patients who underwent routine cholecystectomy were matched for age and time of surgery, of whom 55 (74%) responded to the questionnaire and acted as controls. INTERVENTION: Standardised questionnaire of 112 items, 28 of which referred to problems with eating (Gothenburg Quality of Life Scale). MAIN OUTCOME MEASURES: Differences in scores between the groups. RESULTS: Gastroplasty caused profound changes in patients' lives, cholecystectomy did not. This was reflected in self esteem, relations with partners, and social networking for both sexes. There was no difference between groups in overall quality of life, the mean (SEM) scores for women being 5.32 (0.09) compared with 5.33 (0.07) and for men 5.32 (0.17) compared with 5.40 (0.14). CONCLUSION: Vertical banded gastroplasty seems to offer morbidly obese patients not only reduction in weight but also improved quality of life.

Adult↗
PubMed1994

Nitrous oxide for colonoscopy discomfort: a randomized double-blind study.

The possibility of reducing recovery time after colonoscopy was studied using patient-administered nitrous oxide and comparing it with our standard treatment of ketobemidone plus midazolam. Fifty consecutive colonoscopy patients were randomized to receive either (i) intravenous ketobemidone hydrochloride 2.5 mg, midazolam 2.5 mg, and breathing air from a face mask with a demand valve (KHM) or (ii) intravenous saline and a breathing mixture of even parts of oxygen and nitrous oxide (Entonox) from the same valve setup. Patient discomfort during colonoscopy was assessed using visual analogue scales. All patients were allowed to stay for recovery as long as they wanted, and the time was measured. Modified recollection tests were performed prior to colonoscopy and when the patients left the Endoscopy Unit, in order to study the degree of mental impairment induced by the procedure and the medication. All patients had complete colonoscopies of the same duration in both groups. Discomfort during colonoscopy was rated the same in both groups (2p = 0.6413). Both groups of patients scored identically in the precolonoscopy recollection test. Most patients had a lower score after colonoscopy, but Entonox-treated patients scored significantly better than those with KHM (2p = 0.0250). Patients treated with Entonox opted to leave the Unit directly after the procedure (median 0 minutes; interquartile range 0-5 minutes) compared to 38 minutes for those with KHM (interquartile range 10-75 min), 2p < 0.001. It seems from our data that nitrous oxide gives pain relief equal to that in our standard treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

A randomized, double-blind, placebo-controlled study to evaluate topical anaesthesia of the pharynx in upper gastrointestinal endoscopy.

Reduction of discomfort during diagnostic upper endoscopy may not be desired by patients if the medication has long-lasting and severe after-effects. The present study was designed to examine whether topical anaesthesia of the pharynx without concomitant sedation is of overall benefit to patients undergoing diagnostic upper endoscopy. Two hundred out-patients were randomized to receive in the form of a pharyngeal spray either 80-120 mg lidocaine or placebo. Patients assessed discomfort on a 100 mm visual analogue scale the day after examination. Patients undergoing endoscopy who received lidocaine spray experienced significantly less discomfort from the intubation (p = 0.0001), and discomfort induced by the rest of the examination was also reduced (p = 0.003). The outcome of the endoscopists' assessment was also in favour of lidocaine spray for intubation (p = 0.157) and ease of examination (p = 0.0014). The assessment of throat discomfort suffered by patients after endoscopy did not differ between the groups. A majority of patients, the same proportion in each group, stated they would prefer their next endoscopy to be performed with topical anaesthesia.

Adult↗
PubMed1992

Helicobacter pylori and atrophic gastritis.

Sixty-four consecutive patients which on upper gastrointestinal endoscopy had endoscopic signs of atrophic body gastritis were investigated with standard histology examinations of gastric biopsies, serology and/or culture for Helicobacter pylori and with standard blood chemistry profile. A histologic diagnosis of atrophy could be made in only 27 of the 64 patients (42%). Of these 27 patients, 5 had the pernicious anaemia (PA) type (19%), 22 had not (81%). Past and/or present H. pylori infection was found in 16/22 non-PA patients (73%) but in none of the PA patients (p = 0.00572). The present study thus confirms earlier findings that non-PA type atrophic body gastritis is more common than the PA type and suggests that, as opposed to PA-type atrophy, it is related to H. pylori infection.

Adult↗
PubMed1991

Endoscopic diagnosis of submucosal gastric lesions. The results after routine endoscopy.

The accurate diagnosis of submucosal gastric lesions is difficult. In an attempt to study this problem, the endoscopic records for 8 consecutive years (July 1976-June 1984) were scanned with the help of a computer-based registration of the endoscopic findings. The examinations were identified in which the endoscopic diagnosis indicated the presence of a submucosal tumor. Fifty-four such patients were found in 15,104 routine examinations, giving an incidence of 0.36%. Six patients were lost to follow-up, so the study is based on 48 patients. The most common reason these patients underwent endoscopy was abdominal pain. Five patient groups were identified: (a) nine patients were correctly diagnosed as having gastric wall neoplasia at the initial endoscopy + biopsy; (b) in an additional 13 patients, the suspected gastric wall neoplasia was verified by further nonoperative diagnostic procedures; (c) five patients were found to have benign non-neoplastic gastric disease; (d) five patients had extra-gastric disease that pressed against the gastric wall; (e) in 14 patients a further work-up indicated that the initial endoscopy was false-positive. These five groups were confirmed by additional diagnostic procedures (including laparotomy) and a follow-up time of more than 5 years or autopsy. Two patients refused further examinations and died shortly afterward. No autopsies were performed. Based on our data, it would seem that in the vast majority of patients the suspicion of a submucosal gastric lesion at endoscopy indicates the presence of a serious condition.

Biopsy↗
PubMed1991

Oral sedation for diagnostic upper endoscopy.

Heavy i.v. sedation is often used in upper GI endoscopy. Sedation, however, creates the need for recovery facilities and precludes patients from returning to their normal daily activities. This is undesirable, since endoscopy is routinely performed as an out-patient procedure. Also the cost for medication and recovery facilities militate against the indiscriminate use of i.v. sedative premedication. The present study was undertaken in an attempt to establish what proportion of patients can benefit from oral premedication, and whether such an administration route can eliminate some of the disadvantages associated with i.v. sedation. Four hundred out-patients were randomized to receive orally either triazolam, 0.125 mg, or placebo. Of the patients, 359 were evaluable; 177 received placebo and 182 triazolam. All major aspects of the procedure were covered using visual analogue scale questionnaires for the endoscopist and patient. There were no differences in endoscopic experience, or sex and age distribution between the groups. Triazolam reduced patient discomfort, 38.6 +/- 25.6 vs 44.8 +/- 30.1 (p = 0.0379). Recollection of post-endoscopy information was the same in both groups. One patient complained of drowsiness following the procedure. No patient needed to stay in hospital to complete recovery. Endoscopy quality was identical in the two groups. Oral premedication has the potential to be of significant value, may optimize the use of endoscopy resources, and does not impair patient activities post-endoscopy.

Adult↗
PubMed1991

Anticholinergic medication in diagnostic endoscopy of the upper gastrointestinal tract.

The effects of two different forms of anticholinergic medication on endoscopic quality and patient discomfort were studied in 235 consecutively observed out-patients. Patients were randomized to receive either scopolamine i.v. and placebo transdermally, saline i.v. and saline transdermally, or placebo i.v. and scopolamine transdermally. No differences could be observed between the groups with respect to gastric motor function or endoscopic quality (as judged by the endoscopist), or discomfort during endoscopy (as judged by the patient). Transdermally applied scopolamin resulted in a significant increase (2p = 0.002) in post-endoscopy discomfort due to dryness of the mouth. The findings speak against the use of i.v. scopolamine (20 mg) or transdermally applied scopolamine (0.5 mg) in endoscopy of the upper gastrointestinal tract.

Administration, Cutaneous↗
PubMed1991

Patient attitudes to sedation for diagnostic upper endoscopy.

The presumed need for sedation in upper gastrointestinal endoscopy differs widely between countries and between endoscopists. Very little is known about patient attitudes and the factors that influence patient discomfort. We investigated all ambulatory patients scheduled for diagnostic upper GI endoscopy during a 4-month period (n = 1169) for their attitudes to sedation. One week before the examination they were asked whether they wanted sedation in addition to topical throat anesthesia. A brief description of the endoscopic procedure was given together with an explanation of presumed advantages and disadvantages of sedation. Only 399 patients (34.1%) wanted sedation. The two groups of patients were comparable as to age, gender, and previous experience of endoscopy. Of the 399 patients wanting sedative medication 54.2% were afraid of the diagnosis and 45.8% of the procedure. Male sex and young age were associated with a lower rate of preferring sedation. Patient discomfort during endoscopy was negatively correlated with age (r = -0.309; p = 0.000). Patients who had had more than one previous endoscopy had less discomfort than those without endoscopy experience (p = 0.0069). Men had less discomfort than women (p = 0.0014). The vast majority of our patients preferred 'a normal afternoon to endoscopy sedation'. Young women not previously endoscoped potentially benefit most from sedation.

Adult↗
PubMed1987

Insulin-induced gastric ulcers in the rat.

Low doses of insulin (less than 1.25 IU/kg body weight) stimulate gastric acid secretion in the rat, whereas higher doses (greater than 2.5 IU/kg) release gastrin and cause gastric ulcers but do not increase acid secretion. In this study we have characterized the ulcerogenic properties of insulin in the rat. A dose of 5 IU/kg subcutaneously proved to be maximally effective. Ulcer formation was rapid, and the maximum 90% incidence was reached after 5 h. Both glucose administration and food intake protected against the ulcerogenic effects of insulin. The effects of anti-ulcer drugs and of vagotomy on insulin-induced ulcers were also studied. Animals were divided into seven groups: 1) saline, 2) omeprazole, 3) ranitidine, 4) sucralfate, 5) bilateral vagotomy, 6) unilateral vagotomy, and 7) antrectomy. Medical treatment was continued for 6 days before insulin administration, operations having been performed 6-8 weeks earlier. Insulin was injected subcutaneously in a dose of 5 IU/kg. Five hours later stomachs were inspected for ulcers. Neither the antrectomized rats nor those treated with omeprazole or ranitidine had ulcers. In the saline- and the sucralfate-treated groups the gastric ulcer incidence was 83% and 80%, respectively, with a mean of six and seven ulcers per rat. Ulcers were evenly distributed between the two sides of the stomach. Rats that had undergone bilateral vagotomy (which abolishes gastric acid secretion and causes hypergastrinemia) responded to insulin with an ulcer incidence of 5%. In the unilaterally vagotomized rats there were only 2 ulcers on the denervated compared with 37 on the innervated side.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Ulcer surgery made less expensive. A cost-development study: 1963, 1973, and 1978.

The cost for operative treatment of duodenal ulcer disease over a 15-year period was studied by carefully measuring on a day-to-day basis each cost item separately for every individual. All prices were transformed into 1975 cost level. Statistical analysis revealed a 42% reduction in the cost for operative treatment. This decrement in cost coincided with a change from partial gastrectomy to highly selective vagotomy as the routine procedure. Further refinement of highly selective vagotomy did not result in a further cost decrement.

Adult↗
PubMedDate not supplied

Bioptic techniques in flexible endoscopy. An experimental study in the pig.

Low success rates in biopsies of submucosal gastric lesions have been reported. We undertook an experimental study in the pig of three different and commonly used bioptic techniques to test their ability to provide submucosal material using spiked as well as nonspiked biopsy forceps. The best results were obtained using the Crosta technique where the overlying mucosa is excised using a diathermy snare and biopsies are taken from the bared underlying tissue. The hole-in-hole technique of Seifert and the ethanol injection technique of Asaki were inferior as to bioptic depth but not in size of the biopsies. Biopsy forceps with a central spike were slightly superior to those without.

Animals↗
PubMedDate not supplied

Lack of correlation between fecal blood loss and drug-induced gastric mucosal lesions.

Increased fecal blood loss was produced in healthy volunteers by the administration of two nonsteroidal anti-inflammatory drugs (NSAID), naproxen or fenflumizole. Basal as well as drug-induced gastrointestinal blood loss was measured using 51Cr erythrocyte labeling. Median rise in daily fecal blood loss was 432%. All subjects were endoscoped at the initiation and at the completion of the study. Endoscopic findings were assessed quantitatively by two observers in two different ways. All subjects but three had gastric mucosal lesions at follow-up endoscopy. There was a good correlation between the endoscopic assessments but no statistical correlation between the endoscopic assessment and the increase in fecal blood loss. The data suggest that factors other than gastric mucosal lesions have to be taken into account when investigating NSAID-induced gastrointestinal bleeding.

Adult↗
PubMedDate not supplied

Metoclopramide and ureteric colic.

The pain-reducing property of metoclopramide (Primperan) was compared with that of a narcotic combination drug (Spasmofen) in a double-blind study on 40 patients with ureteric colic. The tested drugs had equal pain-reducing capacity and no serious side-effects were noticed. Metoclopramide appears to be an alternative when inhibitors of prostaglandin synthesis or narcotics are contraindicated.

Adult↗