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Biomedical subjects

K G Tranberg

Publications and source records attributed to K G Tranberg.

At least 55 records · Page 3Linked to original sources
PubMed1990

The accuracy of computed tomography of the liver in colo-rectal carcinoma.

A prospective study in 71 patients with colo-rectal carcinoma was undertaken to evaluate the accuracy of computed tomography (CT) of the liver and arterially enhanced liver CT (CTA). The results were initially based on the findings at surgery. The accuracy of CT was 82% and CTA 84%. Since the evaluation of the liver at surgery is not always correct, a clinical follow-up and repeat CT in the same group of patients was performed. The intention was to search for occult metastatic disease of the liver and thus more accurately evaluate the results of CT, CTA and the surgical evaluation at laparotomy. Both the presence or absence of tumour, as well as the distribution of tumour growth in the liver were considered. In comparison with the results of the follow-up, CT detected the presence and correctly described the tumour distribution in 86%, CTA in 87%, and the surgeon in 88% of the cases, respectively. CTA is recommended if the CT scan is negative or if a more detailed evaluation is required prior to liver resection.

Aged↗
PubMed1990

Use of two-dimensional gas chromatography with electron-capture detection for the measurement of lipopolysaccharides in peritoneal fluid and plasma from rats with induced peritonitis.

The content of 3-hydroxymyristic acid from Escherichia coli lipopolysaccharide in peritoneal fluid and plasma from rats was determined by two-dimensional gas chromatography with electron-capture detection of the 3-O-pentafluorobenzoyl methyl ester derivative. The detection limit of lipopolysaccharide in peritoneal fluid was 3 ng/ml. An experimental model of E. coli peritonitis in the rat was used, with and without coinjection of bile. The concentrations of lipopolysaccharide were highest in both peritoneal fluid and plasma samples from rats injected with E. coli and bile, reaching a maximum 1 h after injection by the gas chromatographic method. Corresponding Limulus assay results for peritoneal samples showed a small increase of lipopolysaccharide concentrations during the first 4 h after injection, followed by a substantial increase. The results indicate that bile salts cause an increased release of lipopolysaccharide from gram-negative bacterial cells in vivo and that this may be responsible for the high mortality caused by peritonitis. In contrast to the Limulus assay, gas chromatography enables the total amount of lipopolysaccharide in a clinical sample to be determined.

Animals↗
PubMed1990

Bile peritonitis in acute cholecystitis.

A review of all patients treated for acute cholecystitis (n = 5848) during an 18-year period (1969-1986) at two hospitals (one practising early surgery in patients with acute cholecystitis and the other not) disclosed that 104 (1.8%) had bile within the abdominal cavity at surgery; 71 with a visible perforation of the gallbladder and 33 without. The bile was infected in 82% of performed cultures (most commonly with Escherichia coli). Mortality was 7.7% (8/104 patients), being 20% (4/20) in the hospital practising delayed surgery and 5% (4/84) in the hospital practising early surgery (p less than 0.10). Infectious complications were responsible for the deaths by leading to multiple organ failure with pulmonary or renal insufficiency or gastro-intestinal bleeding. The timing of surgery was the only factor that had prognostic significance, i.e. the longer the hospital delay before surgery the higher the mortality, although elderly patients or patients with perforation tended to have a worse prognosis. In conclusion, the results of this study indicated that early surgery is important in patients with acute cholecystitis as a means of lowering mortality in bile peritonitis in this condition.

Acute Disease↗
PubMed1990

Liver resection for intrahepatic stones.

Intrahepatic stones are difficult to manage, especially when they are associated with bile duct stricture, cholangitis and destruction of liver parenchyma. Suggested modes of treatment include surgical bile duct exploration, endoscopic procedures, transhepatic cholangiolithotomy and liver resection. This paper reports 2 patients in whom liver resection was performed because of intrahepatic ductal stones, bile duct strictures and repeated episodes of cholangitis. Liver resection was uncomplicated and long-term results were satisfactory. Our results support the view that liver resection is indicated in rare instances of intrahepatic bile duct stones associated with bile duct strictures.

Adult↗
PubMed1990

Subtotal pancreatectomy for cancer: closure of the pancreatic remnant with staplers.

This paper presents a 2-year series of 26 consecutive pancreatectomies for periampullary cancer where the pancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico-digestive anastomosis. The follow-up period was 14 months or more. Seven patients developed operative complications. Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after 2-4 months. Intraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of these patients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of 3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital median stay was 27 days (range 10-83 days). Eighteen patients have died after 4-30 months in recurrent disease and seven patients are alive after a follow-up period of 15-29 months. Pancreatic endocrine function seemed well preserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotal pancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality. Although the conclusion should be tempered by the small number of patients, the results justify continued evaluation of this technique with long-term follow-up.

Adult↗
PubMed1990

Reresection of colorectal liver secondaries: a preliminary report.

During a 4.5-year period, 5 patients underwent reresection of colorectal liver metastases. Two patients died of recurrent disease, 9-11 months after reresection. Three patients are alive, one without and two with recurrent disease, 15, 15 and 68 months after reresection. Although our results suggest that liver reresection may be meaningful in selected patients with colorectal liver metastases, further studies are necessary in order to define candidates for this procedure.

Adult↗
PubMed1990

Reduced insulin secretion by subtotal pancreatectomy: preservation of insulin sensitivity and glucose tolerance in postoperative patients.

This study investigated insulin sensitivity and glucose tolerance after subtotal pancreatectomy for carcinoma of the head of the pancreas. Twelve consecutive, non-diabetic patients were studied after potentially curative surgery at which the distal pancreas was stapled off, leaving approximately 15% of the pancreas in situ. Brief infusions of insulin (10 mU kg-1) and glucose (25 g) were given before and 4 days after operation. Postoperatively, blood glucose levels remained unchanged, whereas fasting levels of insulin. C-peptide, and pancreatic glucagon were decreased, although significantly (p less than 0.01) only for glucagon. The early and late phases of the insulin and C-peptide responses to glucose were severely reduced. Notably, the hypoglycemic action of insulin and the glucose tolerance were similar to those observed before operation. It is concluded that an acute reduction in pancreatic mass does not impair insulin action or glucose tolerance shortly after surgery. This contrasts with the insulin resistance and glucose intolerance seen shortly after pancreas-preserving intra-abdominal procedures of similar size. It is suggested that the decrease in glucagon levels is at least partly responsible for the preservation of insulin action after subtotal pancreatectomy.

Aged↗
PubMed1990

Influence of individual bile acids in Escherichia coli peritonitis.

Previous studies have shown that intraperitoneal bile increases bacterial growth and mortality in Escherichia coli peritonitis in the rat. The purpose of the present study was to determine a) the influence of bile acids (cholic, deoxycholic, or chenodeoxycholic) and bilirubin on survival, bacterial growth, and superoxide release by peritoneal phagocytes in this model, and b) the effect of bile acids on bacterial growth and endotoxin release when incubated with E. coli in vitro. Each of the bile acids aggravated the E. coli peritonitis, with increased bacterial counts in the peritoneal cavity and in blood and increased mortality. Deoxycholic acid was the most deleterious of the bile acids, causing suppression of superoxide release by peritoneal phagocytes, like whole bile. In vitro, bile acids did not seem to affect growth of E. coli, but cholic and deoxycholic acid seemed to enhance the release of endotoxin. It is concluded that the bile acids are responsible for the noxious effect of bile in E. coli peritonitis. It is suggested that the detergent properties of bile acids aggravate the peritonitis by solubilizing the cell membranes of both bacteria and phagocytes.

Analysis of Variance↗
PubMed1990

Effect of bile on peritoneal morphology in Escherichia coli peritonitis.

To investigate whether bile within the abdominal cavity changes the morphologic expression of peritonitis, rats received intraperitoneal injections of saline, bile, Escherichia coli (3 x 10(8) colony-forming units), or E. coli and bile (n = 10 in each group). Specimens were taken from the parietal and visceral peritoneum for light microscopy and scanning electron microscopy, 10 h after induction of peritonitis. Bile alone increased the number of inflammatory cells, especially of the monocytic type. After E. coli alone the monocytic cell response was less pronounced, whereas the polymorphonuclear leukocyte response was comparatively large in the visceral peritoneum. Addition of bile in E. coli peritonitis caused a substantial increase in polymorphonuclear leukocytes, especially in the visceral peritoneum, and in the depth of the inflammatory cell reaction. At scanning electron microscopy mesothelial cells appeared normal after bile alone, had reduced numbers of microvilli after E. coli alone, and were denuded or separated, without microvilli, after E. coli and bile. It is concluded that the inflammatory effects of E. coli are greatly enhanced in the presence of bile.

Animals↗
PubMed1990

Intraabdominal abscess formation after major liver resection.

A series of 138 major liver resections undertaken between 1971 and 1987 were reviewed. Intrabdominal abscesses developed in 11 (8%) patients, a mean of 23 days (range 10-42) after operation and two died (mortality 18%). Eight developed after 63 right hepatectomies, two after 24 right lobectomies, one after 34 left hepatectomies and none after left lobectomies (17). Patients who developed intra-abdominal abscesses underwent significantly longer operations (mean (SEM) 400 (48) compared with 275 (21) min) (p less than 0.05) and had significantly more bleeding during the operation (7,600 (1,750) compared with 3,200 (430), p less than 0.01) than those who did not. The amounts recovered from the abdominal drains, both before and after the diagnosis, were comparatively greater in patients with abdominal abscesses. Antibiotic prophylaxis was given to 10 of 11 patients who did and 89 of 127 patients who did not, form abscesses. We conclude that the risk of intra-abdominal abscess formation after major liver resection is increased: when a large amount of liver tissue is removed (right hepatectomy or lobectomy); when there is a lot of intraoperative bleeding; and when the operation takes a long time. Antibiotic prophylaxis did not affect the risk of abscess formation this series.

Abdomen↗
PubMed1989

Enteral versus parenteral glucose as the sole nutritional support after colorectal resection. A prospective, randomized comparison.

Twenty consecutive patients undergoing resection for colorectal carcinoma were randomized to receive either a glucose polymer by nasojejunal tube or glucose by intravenous infusion as the sole postoperative nutritional support for 4 days. Identical amounts of glucose were given by the two routes. Brief infusions of insulin (10 mU kg-1) and glucose (25 g) were given before and 4 days after surgery for the purpose of metabolic evaluation. Blood glucose was consistently lower in the enteral than in the parenteral group (p less than 0.05). Glucose tolerance and the hypoglycemic response to insulin were impaired after surgery in the parenteral group (p less than 0.01 in both cases) but not in the enteral group. Clearance and release of insulin were similar before and after surgery and were similar in both groups. Patients receiving enteral glucose had less postoperative distress and required fewer doses of analgesic drug (p less than 0.05 in both cases). It is concluded that enteral infusion of glucose preserves insulin action and glucose tolerance after colorectal resection, whereas intravenous infusion of glucose does not. The favorable metabolic effects seen after enteral infusion are accompanied by a reduction of postoperative discomfort.

Adult↗
PubMed1989

Factors influencing the outcome of E. coli peritonitis in rats.

Substances that may influence the course and outcome of intra-abdominal sepsis were investigated in an experimental model of Escherichia coli peritonitis in rats. All rats received an intraperitoneal injection of E. coli. In the first set of experiments, substances commonly contaminating the abdominal cavity after trauma were intraperitoneally injected, and the following mortality rates were found: saline solution (controls) 27%, hemoglobin solution 80% (p less than 0.01), whole blood 20% (p greater than 0.05), whole blood together with bile 93% (p less than 0.001) and bile 87% (p less than 0.01). In the second set of experiments, intravenous injection of commonly used solutions gave mortality rates of 20% (controls) for saline solution, 80% for dextran (p less than 0.01) and 47% for Intralipid (p greater than 0.05). E. coli peritonitis in rats thus was aggravated by intraperitoneal hemoglobin, bile or whole blood plus bile, and also by intravenous dextran.

Animals↗
PubMed1988

Tumour calcification following repeated hepatic de-arterialization in patients: a preliminary communication.

A novel method of repeated hepatic de-arterialization is presented. A vascular occluder is placed around the hepatic artery and connected to an injection port. The hepatic artery can thereafter be occluded repeatedly. Patients with irresectable liver metastases from colorectal cancers were treated with occlusions of the hepatic artery for 1 h twice daily, in combination with intraperitoneal cyclic administration of 5-fluorouracil. The first three patients treated are presented. They all exhibited massive tumour calcifications in the liver reflecting tumour necrosis and resorption. This therapeutic principle must undergo further clinical trials.

Adult↗