PubMed Health⌕ Search

Biomedical subjects

L Enochsson

Publications and source records attributed to L Enochsson.

18 recordsLinked to original sources
PubMed2006

Objective assessment of visuospatial and psychomotor ability and flow of residents and senior endoscopists in simulated gastroscopy.

BACKGROUND: Advanced medical simulators have predominantly been used to shorten the learning curve of endoscopy for medical students and young residents. Rarely have the effects of visuospatial ability and attitudes of intermediately experienced and experienced specialists been studied with regard to simulator training. The aim of this study was to assess the effects of visuospatial ability and attitude on performance in simulator training. METHODS: Eighteen surgical residents were included in the study. Prior to the simulated gastroscopy task, they performed a visuospatial test (the card rotation test). After the simulated gastroscopy task, they completed a questionnaire regarding flow experiences. Their results were compared with those of 11 expert endoscopists who performed the same tests. RESULTS: Total gastroscopy time was significantly shorter for the expert endoscopists compared to residents (2 min 11 sec, p = 0.003). There was also a trend of more mucosa inspected (p = 0.088) and higher efficiency of screening (p = 0.069) by the experts. The residents made fewer errors in the card rotation test than the expert endoscopists (2.5 +/- 0.8 vs 5.5 +/- 1.2, respectively; p = 0.034), and their visuospatial card rotation test results correlated better with their performance in the simulated gastroscopy. CONCLUSIONS: A virtual gastroscopy task presents more of an emotional as well as a psychomotoric challenge to intermediately experienced endoscopists than to senior experts. Our study demonstrates that these differences can be objectively assessed by the use of visuospatial ability tests, flowsheets, and an endoscopic simulator.

Adult↗
PubMed2006

Diagnostic and prognostic implications of DNA ploidy and S-phase evaluation in the assessment of malignancy in biliary strictures.

BACKGROUND AND STUDY AIMS: Brush cytology of biliary strictures has a low sensitivity for diagnosing malignancy, and additional diagnostic tools are needed. The aim of the present study was to assess the diagnostic and prognostic importance of DNA measurements as an adjunct to brush cytology in patients with biliary strictures. PATIENTS AND METHODS: All patients (n = 225) with bile duct strictures who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 1997 and October 2003 at the Department of Radiology at Karolinska University Hospital, Huddinge, Sweden, were included in the study. While 66 patients had an unclear final diagnosis and were therefore excluded, the remaining 159 patients were assessed with brush cytology and DNA flow cytometry. RESULTS: Sensitivity and specificity of DNA aneuploidy for tumor detection were 43 % and 96 %. Using DNA analysis in addition to brush cytology, the sensitivity was 62 % compared with 57 % for brush cytology alone (not significant). Patients with diploid DNA tumors had a significantly better survival than patients with aneuploid DNA tumors ( P = 0.02). The mean survival was 10 months for diploid cancers and 6 months for aneuploid cancers. CONCLUSION: DNA ploidy measurement may be a diagnostic method that could supplement brush cytology in the identification of malignancy in biliary strictures. DNA aneuploidy is a marker of poor prognosis in patients with malignant biliary strictures.

Bile Duct Neoplasms↗
PubMed2005

Chronically administered islet amyloid polypeptide in rats serves as an adiposity inhibitor and regulates energy homeostasis.

AIMS/HYPOTHESIS: Islet amyloid polypeptide (IAPP) reduces food intake and body weight in laboratory animals. In addition, IAPP appears to regulate nutrient metabolism. In the present studies, we investigated the effect of chronic IAPP treatment on different aspects of energy homeostasis. METHODS: IAPP was infused (25 pmol/kg/min) from subcutaneous osmotic pumps for 2-7 days. Rats in 2 saline-infused control groups were fed ad libitum (AF) or pair-fed (PF) against the IAPP-treated rats. RESULTS: As expected, the IAPP infusion reduced food intake and body weight gain. In addition, the IAPP treatment decreased the epididymal fat pad (vs. PF rats, p < 0.05) and lowered circulating levels of triglycerides (vs. PF rats, p < 0.05), free fatty acids (vs. PF rats, p < 0.05), leptin (vs. both AF and PF rats, p < 0.05) and insulin (vs. AF rats, p < 0.05). In contrast, glucose and protein metabolism in the IAPP-treated rats was largely unchanged, as shown in results regarding serum glucose, glucose transport in skeletal muscle, blood urea nitrogen, and glycogen and protein content in the liver and in skeletal muscle. CONCLUSION/INTERPRETATION: In summary, chronic IAPP exposure led to a changed lipid metabolism, which was characterized by decreased adiposity, hypolipidemia and hypoleptinemia, and to unchanged glucose and protein homeostasis. These results were similar to those seen in rodents during chronic exposure to another satiety/adiposity regulator, leptin. In conclusion, chronically administered IAPP plays a role as a satiety and adiposity signal in rats, and helps regulate energy homeostasis.

Adipose Tissue↗
PubMed2005

The influence of alcohol and time on the S-100B levels of patients with minor head injury.

The present study aimed at evaluating the S-100B serum level's reaction to (i) alcohol consumption and (ii) time elapsing between head injury and blood sampling. Nineteen patients with minor head trauma and with at least one of the following symptoms: amnesia, transient loss of consciousness or severe headache, were included in the study. Immediately after arrival venous blood samples were drawn for determination of alcohol concentration and S-100B level. Four hours later a new blood sample was taken for repeat analysis. Twenty-one healthy volunteers drank a moderate amount of alcohol. Blood samples were taken just before alcohol intake and 4 h later. Patients - After 4 h the mean S-100B level had fallen from 0.26 to 0.21 ng/ml (P < 0.01), i.e. a mean decrease of 0.05 ng/ml, 95% confidence limits: 0.02-0.09 ng/ml. The alcohol concentrations also decreased significantly from 2.00 +/- 0.27 per thousand to 1.31 +/- 0.20 per thousand, P < 0.001, mean difference = 0.69 per thousand, 95% confidence limits: 0.27-1.11 per thousand. No difference was found between the S-100B levels of patients whose serum did contain alcohol and the levels of those whose serum did not. Volunteers - The serum alcohol level reached a mean value of 0.81 per thousand +/- 0.09 per thousand. The mean S-100B level rose from 0.077 +/- 0.02 ng/ml before alcohol intake to 0.103 +/- 0.06 ng/ml, 4 h later (P < 0.01). These data indicate that the time that elapses between trauma and blood test has an effect on the S-100B level. The same goes for the drinking of even a very moderate amount of alcohol. The relative importance of these two sources of error remains to be determined.

Adult↗
PubMed2004

The Fenyö-Lindberg scoring system for appendicitis increases positive predictive value in fertile women--a prospective study in 455 patients randomized to either laparoscopic or open appendectomy.

BACKGROUND: Suspected appendicitis is one of the most common indications for acute laparotomy or laparoscopy. The negative laparotomy and laparoscopy rates are high, often in the range of 15-30%, and especially high in some groups of patients such as women of child-bearing age and young patients. Different scoring systems have been introduced in order to improve diagnostic accuracy. The aim of the present study was to analyse the outcome of the Fenyö-Lindberg scoring system in a prospectively randomized multicenter trial and to analyze how well the score performed in stratified subgroups. METHODS: The variables of the Fenyö-Lindberg scoring system were collected in a prospective study comparing laparoscopic and open surgery in suspected appendicitis and with four participating centers. None of the hospitals had used the scoring system previously. Since surgeons were unfamiliar with the score, they could not use it as a diagnostic aid. When comparing the score with the clinical outcome, retrospectively, the investigators interpreting the score were blinded regarding the surgical outcome. RESULTS: Positive predictive value (PPV) of the Fenyö-Lindberg score was higher than that of the surgeon's clinical diagnosis in the patient cohort [0.90 vs 0.79 (p < 0.001)]. The score demonstrated an improvement of PPV in women [0.83 vs 0.70 (p < 0.01)]. PPV was increased in women between 15 and 50 years of age. In women aged 15-30 years and 31-50 years PPV increased from 0.69 to 0.82 and 0.68 to 0.86, respectively (p < 0.01). Both the sensitivity (0.77) and the specificity (0.69) of the score were, however, low. CONCLUSION: The Fenyö-Lindberg score is an inexpensive clinical tool that may improve the diagnostic accuracy for acute appendicitis in women of childbearing age, which is a group of patients where the diagnostic accuracy usually is low and where the arsenal of diagnostic tools such as computed tomography is limited because of radiation. The low specificity of the score in women of childbearing age must, however, be kept in mind.

Adolescent↗
PubMed2004

Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience.

BACKGROUND: There is still some controversy regarding the optimal timing and best method for the removal of common bile duct stones (CBDS). Intraoperative endoscopic retrograde cholangiopancreaticography (IO-ERCP) is an alternative method that should be considered for this procedure. The aim of our study was to investigate the clinical outcome of a single-step procedure (IO-ERCP) to remove CBDS, thereby combining two existing high-volume clinical modalities-i.e., laparoscopic cholecystectomy (LC) and ERCP. METHODS: Between January 2000 and December 2001, 674 patients, 192 male and 482 female, underwent cholecystectomy at our hospital. There were 612 LC (90.8%), 37 converted procedures (5.5%), and 25 open operations (3.7%). In 592 of the patients, (87.8%) intraoperative cholangiography (IOC) was performed. In 34 (5.7%) of those who had and IOC, an IO-ERCP was performed. While the surgeon waited for the endoscopist, care was taken to introduce a thin guidewire through the lOC catheter and pass it through the sphincter of Oddi, out into the duodenum. This complementary procedure greatly facilitated the subsequent cannulation of the bile ducts. RESULTS: The cannulation frequency of the CBD was 100%. Common bile duct stones were successfully extracted in 93.5%. Endoscopic sphincterotomy (EST), followed by the insertion of a plastic endoprosthesis, was performed in two patients with remaining stones. The CBD of these two patients was cleared by postoperative ERCP. None of the patients developed postoperative pancreatitis. The operating time was prolonged as compared with the time for LC (192 vs 110 mins; p < 0.05). The length of hospitalization for IO-ERCP patients did not differ from that for patients undergoing cholecystectomy alone (2.6 vs 2.1. days; NS). CONCLUSIONS: The study suggests that elective IO-ERCP is a safe and efficient method for removing CBDS that has a low risk of inducing postoperative pancreatitis and does not prolong postoperative hospitalization. This technique enables perioperative extraction of CBDS without open or laparoscopic surgical exploration of the CBD and can be used safely in a routine clinical setting.

Adolescent↗
PubMed2001

Laparoscopic vs open appendectomy in overweight patients.

BACKGROUND: Laparoscopic appendectomy (LA) has been associated with a faster recovery and less postoperative pain than the open technique. However, few data are available on the clinical outcome of LA in overweight patients. METHODS: A group of 106 patients with a body mass index (BMI) > 26.4, representing the upper quintile of 500 prospectively randomized patients, were included in the study. They were randomized to undergo either laparoscopic or open appendectomy (OA). Operating and anesthesia times, postoperative pain, complications, hospital stay, functional index (1 week postoperatively), sick leave, and time to full recovery were documented. RESULTS: In OA, the operating time for overweight patients was significantly longer than that for patients in the normal weight range (40 vs 35 min, p < 0.05). In LA, there was no difference in operating time between the normal and overweight patients. Overweight patients who underwent LA had longer operating and anesthesia times than their OA counterparts (55 vs 40 min, p < 0.001; and 125 vs 100 min, p < 0.001, respectively). Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique. Postoperative pain was also significantly greater in overweight patients subjected to OA than in patients of normal weight after 4 weeks; the clinical significance may, however, be of less importance since the values are low (0.26 vs 0.09, p < 0.05). There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA (3.0 vs 2.0, p < 0.01). The functional index did not differ between any group of patients. Sick leave was longer for overweight patients who underwent OA than for normal-weight patients treated with the same technique (17 vs 13 days, p < 0.01). In the laparoscopic group, however, there were no differences between the overweight and normal-weight patients. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group (22 vs 15 days, p < 0.001). CONCLUSION: In this study, overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweight patients who had OA. LA also abolished some of the negative effects that overweight had on operating time, hospital stay, and sick leave with the open technique. However, anesthesia and operating times were significantly longer in LA for both overweight patients and those with a normal BMI.

Adolescent↗
PubMed2001

Contrast radiography in small intestinal obstruction, a valuable diagnostic tool?

OBJECTIVE: To investigate the diagnostic and therapeutic potential of plain abdominal radiographs and contrast radiography in patients with suspected small intestinal obstruction. DESIGN: Retrospective study. SETTING: General hospital, Sweden. MATERIAL: 2357 sets of plain abdominal radiographic casenotes. MAIN OUTCOME MEASURES: Analysis of plain abdominal radiographs for small intestinal obstruction. Establishment of the time that subsequent contrast radiography medium took to reach the caecum, and its success rate. RESULTS: Of the 2357 plain abdominal films 1599 (68%) did not show small intestinal obstruction, 425 (18%) showed intermediate obstruction, and 333 (14%) showed small intestinal obstruction. The water-soluble contrast medium reached the colon in 394/591 (67%) of the cases with intermediate or complete small intestinal obstruction. Although the contrast medium passed to the colon there was remaining abnormality with dilated small intestine in 71/212 (33%) of the cases with intermediate obstruction and in 95/143 (66%) of the small intestinal obstruction group. The time for the contrast medium to reach the colon was 3.4 hours in the normal group, 5.5 hours in the intermediate group and 8.9 hours in the obstruction group. CONCLUSION: The plain abdominal radiographs seem to predict the success of follow-through examinations. Contrast radiography is safe and may have a therapeutic potential in small intestinal obstruction.

Acute Disease↗
PubMed2001

Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?

OBJECTIVE: To analyse the reasons for, and outcome of, conversion from laparoscopic to open appendicectomy and to identify factors that may predict the need for conversion. DESIGN: Subgroup analysis from a randomised multicentre study. SETTING: One university hospital and four county hospitals, Sweden. SUBJECTS: A total of 500 patients were randomised to laparoscopic (n = 244) or open (n = 256) appendicectomy. Thirty operations (12%) were converted to open appendicectomy. MAIN OUTCOME MEASURES: Reasons for conversion, outcome, and preoperative predictive variables. RESULTS: Difficult anatomy or the presence of an abscess were the main reasons for conversion (25/30). The incidence of perforated appendicitis was higher among patients who required conversion compared with both the open and laparoscopic group. Operating time, anaesthetic time, and duration of hospital stay were longer after conversion. Time to full recovery and length of sick leave were also longer, except for patients with perforated appendicitis. There was no difference in the complication rate. No predictive factors were identified. CONCLUSION: The main reasons for conversion were difficult anatomy and the presence of an abscess. After conversion patients recovered more slowly than those operated on laparoscopically or by primary open operation.

Adolescent↗
PubMed2000

[Acute abdomen calls for considerable care resources. Analysis of 3727 in-patients in the county of Stockholm during the first quarter of 1995].

A total of 3,727 in-patients with acute abdominal symptoms were identified during the first quarter of 1995 at the surgical clinics of the nine hospitals with emergency departments in the county of Stockholm. The diagnoses were: non-specific abdominal pain 24%; cholecystitis 9%; appendicitis 8%; bowel obstruction 7%; intra-abdominal malignancy, diseases of the urinary tract and peptic ulcer 6% each; gastrointestinal hemorrhage, diverticulitis of the colon and pancreatitis 5% each; other diseases as a cause of abdominal symptoms, 19%. 1,601 operations were performed of which 47% were endoscopic procedures. The mean duration of hospital stay was 4.8 days. The length of stay increased significantly with age. The age-related relative frequency of hospitalization due to acute abdominal pain was also dramatically higher in the elderly cohorts. These facts and the prognosis of an 18% increase of inhabitants 50 years of age or older until 2010 in Greater Stockholm signal an increased need of hospital resources for this large group of patients in the coming years.

Abdomen, Acute↗
PubMed1999

Prospective randomized multicentre study of laparoscopic versus open appendicectomy.

BACKGROUND: A prospective randomized multicentre study was performed to compare the outcome of laparoscopic and open appendicectomy in patients with suspected acute appendicitis. METHODS: A total of 523 patients was randomized, but because of 23 withdrawals the outcome in 500 patients is reported, 244 in the laparoscopic group and 256 in the open group. RESULTS: Patients having laparoscopic appendicectomy recovered more quickly than those having open surgery (13 versus 21 days, P < 0.001). There was no significant difference in duration of sick leave after operation (laparoscopic group 11 days versus open group 14 days). Postoperative pain (at 24 h, 7 days and 14 days) was less after laparoscopic operations and a functional index 1 week after operation was more favourable in these patients (P < 0.001). Operating time was significantly longer in the laparoscopic group (60 versus 35 min, P < 0.01). Hospital stay and complications did not differ between the groups. Thirty laparoscopic procedures (12 per cent) were converted to open appendicectomy. CONCLUSION: Laparoscopic appendicectomy is as safe as open appendicectomy and has the advantage of allowing a quicker recovery.

Acute Disease↗
PubMed1997

Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system.

OBJECTIVE: To validate a simplified scoring system as an aid to the diagnosis of acute appendicitis. DESIGN: Open prospective study. SETTING: County district hospital, and university hospital, Sweden. SUBJECTS: 1167 Patients with suspected appendicitis. MAIN OUTCOME MEASURES: Correlation between scoring system and final diagnosis. RESULTS: A total of 475 patients were operated on and 392 (82.5%) of these had histologically verified appendicitis. The negative laparotomy rate was 17.5% (11.2% for men and 25.4% for women). The sensitivity of the scoring system for appendicitis at the main cut-off point (score -2 or more) was 0.73 and the specificity was 0.87. At the cut-off level (score - 17 or less) for predicting non-specific abdominal pain (NSAP) the proportion of correctly classified patients was 0.72 and the proportion of false negatives (patients with appendicitis classified as NSAP) was 0.14. Analysis of the area under the receiver operating characteristic (ROC) curve showed that the scoring system performed slightly worse in the university hospital (area 0.83) than in the district hospital where it was originally developed (area 0.89). CONCLUSION: The scoring system was a valid instrument for discriminating between acute appendicitis and NSAP in the two centres studied. Use of the scoring system in daily clinical work was associated with a reduced rate of negative laparotomies.

Acute Disease↗
PubMed1987

Myoelectric motility patterns during mechanical obstruction and paralysis of the small intestine in the rat.

The purpose of the present study was to analyze changes of the myoelectric activity in experimental mechanical obstruction and paralytic ileus of the small intestine. Myoelectric activity was recorded in the upper small intestine of conscious, fasted rats by three bipolar electrodes implanted 10 cm apart. In the basal state regular myoelectric motility complexes (MMCs) were registered in all experimental animals. Obstruction of the small intestine (n = 13) was produced by a ligature between the middle and distal electrodes. Proximal to the obstruction regular MMCs continued. After 45 +/- 15 min at the middle (p less than 0.01), and 85 +/- 10 min at the duodenal electrode (p less than 0.01), MMCs disappeared. Another motility pattern was established, characterized by clusters of spikes, occurring regularly with 2-min intervals, separated by short silent periods, and a rapid aboral migration (p less than 0.01). Distal to the obstruction the propagation of MMCs was immediately disrupted. After a quiescent period of 13 +/- 3 min irregular spiking occurred and continued throughout the experiment (p less than 0.01). Intraperitoneal instillation of 0.1 M hydrochloric acid (n = 8) produced a prompt and long-lasting inhibition of the MMCs. The quiescence lasted for 70 +/- 23 min, until the MMCs reappeared (p less than 0.01). It is concluded that complete intestinal obstruction is followed by a series of significant and well-defined changes of myoelectric activity on both sides of the obstruction. Nociceptive stimulation of the peritoneum produces intestinal paralysis. The immediate inhibition of the motility indicates that the paralysis is not secondary to inflammatory reactions.

Animals↗
PubMed1986

Effects of intraluminal hydrostatic pressure on L-methionine absorption in the obstructed small intestine of the rat.

The effects of elevated intraluminal hydrostatic pressure on the active absorption of the amino acid selenium 75 L-methionine has been analyzed in the normal and obstructed small intestine. An intestinal loop of defined position and length was included in a recircling perfusion system from which the elimination rate of the radiolabeled amino acid was measured. Preset pressure levels within the system were maintained by a servo-controlled unit, which added or subtracted volume to keep the pressure constant. The rate of amino acid elimination increased when the nonobstructed loop was subjected to a pressure of 10 cm H2O but decreased when exposed to 20cm H2O. Using a loop of intestine subjected to 48 hours of obstruction, amino acid elimination was greatly retarded compared with that of the nonobstructed loop. By increasing the intraluminal pressure to 10 and 20 cm H2O, the elimination rate increased, equalling that of the nonobstructed gut. The results suggest that intestinal obstruction per se decreases active absorption secondary to impaired intestinal viability. Moderately increased intraluminal pressure adds a driving force to L-methionine absorption, the mechanism of which is obscure.

Animals↗
PubMed1986

Mechanical compliance of the small intestine related to long-standing obstruction. An experimental study in rats.

Mechanical compliance was studied in rat small intestine subjected to 48 hours of simple obstruction. The values were compared with those obtained in a corresponding section of normal gut. A closed system was used, constructed for continuous measurement of volume-pressure relationships within a hollow organ. The pressure-raising velocity was regulated by programming a steering unit connected to the system. The findings accorded with the hypothesis of an increase in compliance of the obstructed small intestine. The experiments further demonstrated that repeated artificial increases in intraluminal pressure cause change in intestinal compliance.

Animals↗
PubMed1982

Effects of intraluminal pressure on regional blood flow in obstructed and unobstructed small intestines in the rat.

Small bowel circulation in the rat was studied with the microsphere technique before and after 10 minutes of elevated intraintestinal pressure. A distal small bowel loop consisting of 10 vascular arcades was used. The specimens were inflated with nitrogen gas. Regional blood flow in both obstructed and unobstructed small bowels was significantly diminished by an intraintestinal pressure of 40 mm Hg. A pressure of 20 mm Hg impaired circulation only in the obstructed small intestine, whereas the unobstructed intestine did not show a similar decrease. These findings suggest that moderate intraluminal pressures can imply a potential hazard to the vulnerable capillary bed of an obstructed intestine. Hence, it is suggested that intraoperative decompression should be performed to avoid this postoperative threat to bowel viability.

Animals↗
PubMedDate not supplied

Reference sample microsphere method to measure blood flow effects on small intestinal perfusion in the rat.

To evaluate whether the microsphere method, including the necessary surgical procedures, for blood flow determination creates hemodynamic stress and a secondary reduction in small intestinal perfusion, we monitored the small intestinal perfusion with laser Doppler (LD) fluxmetry in 3 groups of Sprague-Dawley rats. Group I was studied during two microsphere injections without manipulation, group II was subjected to mesenterial-root occlusion during the second injection, and for group III, vasodilatation with papaverine preceded the second injection. While cardiac output and kidney blood flow were constant at the two microsphere injections, mean blood pressure (p < 0.05) and hematocrit (p < 0.01) significantly decreased in all 3 groups. Blood glucose increased significantly (p < 0.01). LD values also declined significantly (p < 0.05) between the start and end of experiments. In group I, the initial values of 9.5 perfusion units (PU) (5-23) decreased to 6.5 PU (3-12), in group II, 10.5 PU (5-24) decreased to 7.0 PU (4-15) and in group III, 9.0 PU (5-13) decreased to 5.5 PU (4-12). In conclusion, these findings suggest that the microsphere technique with two injections of spheres and reference sample withdrawals may affect the perfusion of the small intestine in the Sprague-Dawley rat.

Animals↗