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Biomedical subjects

L Friman

Publications and source records attributed to L Friman.

At least 19 recordsLinked to original sources
PubMed1987

Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female.

A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparocentesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.

Adolescent↗
PubMed1984

Recording of bone marrow activity in liver-spleen (RES) scintigraphy.

The bone marrow activity in the liver-spleen (RES) scintigraphy has been difficult to estimate correctly. If the activity of the bone marrow is to be decided as counts/time unit it is of importance that structures with a high activity as the liver and spleen are excluded from the registration. A dorsal registration of the pelvis during 180 s will give a rather correct information of bone marrow activity and besides an image of the pelvic bone marrow is obtained. Using 270 to 280 MBq 99Tcm-Albures all 45 normal cases had values below 150 KCNT (1 KCNT = 1 000 counts). All cases with cirrhosis (n = 15) or metastases in the liver (n = 14) had values over 150 KCNT. Values over 150 KCNT were also found in 29 of 34 patients with an increase in ASAT and ALAT (GOT, GPT) as the only pathologic finding and in 12 of 21 patients with a carcinoma but without metastases in the liver.

Aged↗
PubMed1981

Distribution of the extrahepatic uptake in liver diseases as recorded by scintigraphy.

Liver scintigraphy performed with 99Tcm-S and Sn colloid ought to be named RES scintigraphy as the distribution of the colloid is mainly determined by the phagocytic capacity of the RES but also by the regional blood flow and the features of the colloid. Both diffuse hepatocellular disease and malignant disease may have decreased activity in the liver and increased extrahepatic activity: spleen, bone marrow and lungs. In liver cirrhosis at least 3 types of distribution of activity can be recognized: (a) equal increase in spleen, bone marrow and lungs, (b) mainly increase in spleen, and (c) mainly increase in bone marrow and lungs. Therefore a ratio between the total extrahepatic and the hepatic activity ought to be calculated rather than a spleen/liver ratio.

Adenoma, Bile Duct↗
PubMed1981

Reticuloendothelial function in patients with alcoholic liver cirrhosis.

The phagocytic and metabolic functions of the reticuloendothelial system (RES) were tested in seven patients with advanced cirrhosis of the liver due to excessive ingestion of ethanol. 125I-labelled microaggregated human serum albumin was used as a test substance. A group of 13 volunteers served as controls. Liver and spleen scans were performed in all patients. Routine blood analyses were made, including seven different liver tests. The results show that both the phagocytic and the metabolic activity of the RES were hampered significantly in all these patients compared with the control group. The liver and spleen scan findings were all pathological, showing a good correlation with the RES function test. The blood test that correlated best with the RES function test was the prothrombin time, which was likewise abnormal in all patients. It is concluded that certain functions of the RES are hampered after prolonged ethanol ingestion and that the enhanced frequency of infections in patients with alcohol liver cirrhosis might partly be due to their impaired RES function.

Aged↗
PubMed1980

Splenomegaly, hyperkinetic splenic flow and portal hypertension in colitis.

Four patients with a long history of colitis, splenomegaly, hypersplenism and portal hypertension were examined with angiography, both with contrast medium and isotopes, liver-spleen scintigraphy and recording of portal pressure. At angiography hyperkinetic splenic and portal blood flow was demonstrated. The increased flow causes increased portal pressure, which probably gives rise to changes in the liver often considered as slight cirrhosis at microscopy. The scintigraphic findings differed from Laennec cirrhosis. The liver uptake was homogeneous and no activity in the skeleton was recorded. Splenectomy cures both the hypersplenism and portal hypertension.

Adult↗
PubMed1980

Effect of somatostatin on regional splanchnic blood flows in man. Angiographic studies.

The effect of somatostatin (1 microgram/kg b.w. i.v. over one minute) on regional splanchnic blood flows was studied in nine patients subjected to diagnostic angiography of the coeliac artery, the superior mesenteric artery or the aorta. Following somatostatin there was a prolongation of the circulation times and a marked constriction of the hepatic and splenic vascular beds corresponding to a 50% decrease in blood flow. Blood flow in the gastroduodenal, pancreatic, superior mesenteric and renal arteries was also decreased, but to a lesser extent. There was no effect on the lumbar arterial flow. The time for maximum filling of the portal vein was delayed and the contrasting effect in this vessel was decreased, indicating a decrease in portal flow. It is concluded that somatostatin reduces splanchnic blood flow in unanaesthetized man, while there is no decrease in skeletal muscle blood flow. It is suggested that this effect of somatostatin is due to a direct action on vascular receptor sites.

Angiography↗
PubMed1979

Portal pressure correlated to visceral circulation times.

Visceral angiography was performed in 7 patients with normal portal pressure and in 10 with portal hypertension. Circulation times, size of vessels and portal pressure were determined. At celiac angiography a direct correlation was found between time for maximum filling of portal vein and portal pressure, provided no vascular abnormalities existed. At superior mesenteric angiography such a correlation was not found; loss of flow by shunts in portal hypertension being one explanation. Portocaval shunts are common in the celiac system, but uncommon in the superior mesenteric system.

Adolescent↗
PubMed1978

Living related kidney donors: complications and long-term renal function.

Sixty-two living related kidney donors were nephrectomized during a 10-year period. The overall complication rate was 40%, most complications being minor. Among the major complications was one patient with pulmonary embolism and three patients with hepatitis. One female donor suffered a psychoneurotic reaction following rejection of the donated kidney and she is still away from work, more than 2 years later. The other 61 donors were back to work within 2 to 18 (mean 8) weeks. The mean serum creatinine livels increased from 0.95 preoperatively to 1.15 mg/100 ml at the followup examination, which took place between 6 months and 9 years after nephrectomy. The mean increase in serum creatinine was higher in donors above 50 years of age (P less than 0.02). The mean creatinine clearance of the whole group decreased from 111 to 90 ml/min. The mean increase in size of the remaining kidney was 22%. Donor nephrectomy is a safe procedure with few serious complications and the prognosis for the recipient is excellent. Therefore, we consider transplantation from a family member to be the treatment of choice in terminal uremia.

Adult↗
PubMed1976

Stenosis following tracheostomy. A quantitative study of long term results.

Seventy out of the 320 patients treated with tracheostomy and respiratory care in an intensive care unit, were included in a follow-up study. A variety of surgical (38) and medical (32) conditions had prompted IPPV for 1-59 days; 33 had had primary and 37 secondary tracheostomies. The final study included an interview, physical examination, radiographic examination and spirometry. Using radiographic measures, the area of stenosis was calculated as well as the pressure drop across the stenosis at various flow rates. The methods of calculation were tested in one patient and compared with the actual tracheal pressure and gas flow recordings. Lateral stenosis was found in 69 and frontal stenosis in 25 patients, the length being 0-2-5-0 cm. The stenosis was situated at the level of the stoma in 59, at the cuff in 6, and at both sites in 2; in 2 the level could not be determined accurately. The mean area of normal trachea was 2-8+/-0-8 cm2 in females and 3-7+/-0-7 cm2 in males, while the stenotic area ranged from 0-86 to 4-54 cm2. A stenosis of potential functional significance was found in 8 patients (area less than 1-5 cm2). The stenotic area correlated well with the pressure drop across the stenosis and better than with the stenosis percentage (1-74%). The predicted pressure falls over the stenosis at different flow rates were in excellent agreement with those measured in one patient. Spirometry was unsuitable for detecting the stenosis. Poor correlation were found between the degree of tracheal stenosis and chronic respiratory disease, smoking, age, interval between intubation and tracheostomy, or duration of IPPV. Dysponea during moderate exercise was present in all patients who had a pronounced stenosis.

Female↗
PubMed1976

Subcutaneous arteriovenous fistulas for dialysis with special emphasis on vascular insufficiency.

Ninety-four subcutaneous arterio-venous fistulas were created for haemodialysis in 83 patients. Seventy-one patients eventually received well-functioning fistulas. The most common complication was thrombosis at the suture line. Thus, 8 primary fistulas clotted within 24 hours of surgery and 5 clotted later. Eleven patients were reoperated with a successful result in six. One patient developed arterial insufficiency in the hand with finger ulcerations, probably due to a radial steal syndrome. Four patients got extremely swollen hands and threatening gangraena because of thrombosis of the vein proximally to the anastomosis. Vital capillary microscopy in the patients with vascular insufficiency demonstrated profound changes of the nutritional capillaries which were not seen in control patients with well-functioning fistulas. After closure of the fistulas the edema disappeared and the ulcerations healed rapidly.

Adult↗