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Biomedical subjects

L Granström

Publications and source records attributed to L Granström.

At least 37 records · Page 2Linked to original sources
PubMed1996

Gastro-oesophageal reflux before and after vertical banded gastroplasty in the treatment of obesity.

OBJECTIVE: To study the long term effect of vertical banded gastroplasty on lower oesophageal sphincter pressure. DESIGN: Prospective study. SETTING: University hospital, Sweden. SUBJECTS: 21 morbidly obese patients (mean body mass index 42.5). INTERVENTIONS: Vertical banded gastroplasty, together with measurements of endoscopic grade, oesophageal manometry, and 24 hour pH before, and a mean of 38 months after, operation. MAIN OUTCOME MEASURES: Weight, grade of oesophagitis according to the Savary-Miller classification, number of episodes of reflux, percentage of time that the pH was < 4, and lower oesophageal sphincter pressure. RESULTS: Before operation 5/14 patients (36%) had evidence of oesophagitis, and 12/21 (57%) had evidence of reflux disease. Two patients had abnormally low lower oesophageal sphincter pressure ( < 10 mm Hg). A mean (SEM) of 32 months after operation (range 6-49) the mean body mass index was 32.7 (1.2), and after a mean of 38 months paired data showed that there had been no significant changes in manometric (n = 11) or 24 hour pH (n = 10) measurements, or in endoscopic grading (n = 7). CONCLUSION: Vertical banded gastroplasty used in the treatment of morbid obesity does not affect the antireflux function of the lower oesophageal sphincter.

Esophagitis, Peptic↗
PubMed1995

Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis.

In a prospective controlled study the effect of antibiotics as the only treatment in acute appendicitis was evaluated. Of 40 patients admitted with a duration of abdominal pain of less than 72 h, 20 received antibiotics intravenously for 2 days followed by oral treatment for 8 days and 20 considered as controls were randomized to surgery. All patients treated conservatively were discharged within 2 days, except one who required surgery after 12 h because of peritonitis secondary to perforated appendicitis. Seven patients were readmitted within 1 year as a result of recurrent appendicitis and underwent surgery, when appendicitis was confirmed. The diagnostic accuracy within the operated group was 85 per cent. One patient had perforated appendicitis at operation. Antibiotic treatment in patients with acute appendicitis was as effective as surgery. The patients had less pain and required less analgesia, but the recurrence rate was high.

Acute Disease↗
PubMed1995

Does the Size of the Upper Pouch Affect Weight Loss after Vertical Banded Gastroplasty.

BACKGROUND: The importance of creating a small 10-20 ml upper pouch when performing a vertical banded gastroplasty (VBG) is often stated in the literature. In order to test the hypothesis that weight loss is superior in patients with a small upper pouch, we examined the weight loss curves for three different pouch sizes in our patients operated with VBG. METHOD: Retrospective analysis of patients operated with VBG at our institution between November 1986 and April 1994 was done. A modified Mason VBG was performed with intraoperative balloon measurements of the size of the upper pouch. Three groups were identified according to different pouch volumes: 20 ml (n = 65), 30 ml (n = 46), and >/= 40 ml (n = 47). RESULTS: Of the 198 patients operated with VBG, pouch volume measurement was successful in 158 patients. Mean pouch volume was 32 ml at 50.5 cm of water. Loss of body mass index at 6, 12, 24, 48, 60 months did not significantly differ in the three groups. The rate of late reoperative procedures was also similar in the three groups. The incidence of staple-line breakdown (SLB) and endoscopically verified esophagitis was higher in the >/= 40 ml group. CONCLUSION: We have been unable to demonstrate a difference in weight loss after VBG for differing pouch volumes. There is an increased rate of SLB and esophagitis in the group with largest pouch volume; however, length of follow-up was longest for this group.

Journal Article↗
PubMed1995

Serial antenatal monitoring compared with labor induction in post-term pregnancies.

OBJECTIVE: In view of the increased risk of obstetric and perinatal complications in post-term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks. MATERIALS AND METHODS: A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 gravidae admitted for induction of labor at 42 weeks. A third, high-risk, group comprised gravidae (from either of the foregoing groups) who had to be admitted for emergency induction of labor owing to increased fetal risk (i.e., the presence of oligohydramnios or a small-for-gestational-age fetus). RESULTS: The frequency of labor induction was significantly lower in the study group than among controls (p < 0.001), but the two groups did not differ in obstetric or perinatal outcome. As compared with these two low-risk groups, the high-risk group was characterized by significantly higher frequencies of instrumental delivery (p < 0.01), operative delivery for fetal distress (p < 0.001) and infants requiring neonatal intensive care (p < 0.001). CONCLUSION: As the wait-and-see policy with serial monitoring resulted in a lower rate of labor induction, but not in a lower rate of instrumental delivery or perinatal complication, medically the two routines would appear to be comparable. However, an individual approach with intensified fetal surveillance is to be recommended, as it is vital to identify post-term pregnancies where the fetus is at increased risk. The use of such new techniques as umbilical artery flow velocimetry would no doubt improve the management of high-risk post-term pregnancies.

Cardiotocography↗
PubMed1995

Cervical fetal fibronectin correlates to cervical ripening.

AIM OF STUDY: It is well established that the cervical ripeness is of great prognostic value at labor induction. The available methods of measuring the cervical ripeness are not satisfactory. This study was therefore initiated to investigate if there is any correlation between cervical fetal fibronectin and cervical ripening at term. METHOD: Three groups were included in this study: women with unripe cervices, women with spontaneous cervical ripening and those with PGE2-induced cervical ripening. Fetal fibronectin was measured by ELIZA after sampling from the cervical canal. RESULTS: The cervical fetal fibronectin was low in women with unripe cervices. In women with favorable cervices a ten fold higher level was found. The fibronectin level was even higher after PGE2-induced ripening. CONCLUSION: Conclusively an increased amount of cervical fetal fibronectin is registered during the cervical ripening process. A level of > 0.80 microgram/ml of cervical fetal fibronectin seems to indicate a favorable cervix.

Adult↗
PubMed1995

Ultrasonographic findings after conservative treatment of acute appendicitis and open appendicectomy.

In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis. Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery. All patients were examined prior to randomization, after 10 days and after 30 days. Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis. At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients. In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day. In 5 of the 8 patients the appendix was still visualized after 1 month. Three of these 5 had recurrent appendicitis within a year. It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

Acute Disease↗
PubMed1995

Sensitivity of interleukin-6 and C-reactive protein concentrations in the diagnosis of acute appendicitis.

OBJECTIVE: To evaluate the interleukin-6 (IL-6) concentration in the diagnosis of acute appendicitis, either as a single or four-hourly test. DESIGN: Open study. SETTING: Teaching hospital, Sweden. SUBJECTS: 165 consecutive patients admitted with suspected acute appendicitis. MAIN OUTCOME MEASURES: Correlation of concentrations of IL-6 and C-reactive protein with white cell count, duration of symptoms, and histological appearance of the appendix. RESULTS: Of 165 patients, 101 patients had their appendices removed, and of these 86 had histologically confirmed appendicitis. An IL-6 concentration of less than 15 ng/l was accepted as the reference. On admission IL-6 concentrations above 15 ng/l gave a sensitivity of 66% and a specificity of 31% for acute appendicitis. Repeated tests were of no value. When the patients operated on were divided in groups depending on the duration of symptoms, C-reactive protein was the most valuable test after 24 hours' abdominal pain. Total white cell count has the most sensitive in patients with abdominal pain of less than 24 hours' duration. CONCLUSIONS: Measurement of IL-6 concentrations does not increase the accuracy of the diagnosis of acute appendicitis. There was no significant correlation between IL-6 and C-reactive protein concentrations.

Acute Disease↗
PubMed1995

Leucocyte elastase as a marker in the diagnosis of acute appendicitis.

OBJECTIVE: To investigate the value of measuring the activity of the leucocyte elastase complex in plasma in the diagnosis of acute appendicitis, either as a single or four-hourly test. DESIGN: Open study. SETTING: Teaching hospital, Sweden. SUBJECTS: 165 consecutive patients admitted with suspected acute appendicitis. MAIN OUTCOME MEASURES: Correlation of concentrations of leucocyte elastase complex (elastase) and total white blood cell count (WBC) with C-reactive protein concentration and histological appearance of the appendix. RESULTS: Of 165 patients, 101 patients had their appendixes removed, and of these 86 had histologically confirmed appendicitis. An elastase value of less than 54 micrograms/l was considered to be the reference range. Elastase activity measured on admission gave a sensitivity of 61% and a specificity of 43% for acute appendicitis compared with the WBC which had a sensitivity of 81% and a specificity of 36%. The above blood tests were taken on two or more occasions four hourly after admission in 29 patients. Appendicitis was found in 25 of the 29 cases (87%), in which repeated tests showed a significant reduction in WBC together with a definite but not significant reduction in the elastase activity during the preoperative period. Repeated tests were of no value. CONCLUSIONS: Measurement of the leucocyte elastase complex in plasma does not increase the accuracy of the diagnosis of acute appendicitis. There was no significant correlation between the leucocyte elastase activity and the total white cell count.

Acute Disease↗
PubMed1994

Marlex Mesh Gastric Banding: A 7-12 Year Follow-up.

This paper presents a 7-12 year (mean 9.8 years) follow-up of 92 extremely obese patients treated with Marlextrade mark mesh gastric banding (GB). The follow-up rate was 92% (85 patients). Weight loss was initially good (an average reduction in BMI of 13 during the first year), but late weight gain has been a common complaint and a reason for reoperation. Other complications that necessitated reoperation were severe vomiting and esophagus not amenable to medical treatment. Four patients have developed signs of Barrett's esophagus at late follow-up. Forty-six patients (50%) were reoperated 70 times for correction of the band or conversion to vertical banded gastroplasty (VBG). The most common reoperative procedure was conversion to VBG (38 patients). Only 25 (31%) of the 80 patients with long-term follow-up have an intact band. Our results show the need of long follow-up and that this GB cannot be recommended for the treatment of morbid obesity.

Journal Article↗
PubMed1994

The diagnostic value of repetitive preoperative analyses of C-reactive protein and total leucocyte count in patients with suspected acute appendicitis.

BACKGROUND: Studies have shown that C-reactive protein (CRP) and total leucocyte count (WBC) in suspected acute appendicitis analysed only on admission gave valuable information to guide the surgeon. The aim of this study was to investigate the usefulness of CRP and WBC measured repetitively before operation. METHODS: During a 1-year period 227 patients were studied before emergency appendicectomy. CRP and WBC were analysed every 4th h. The upper limits of the reference intervals used were 9.0 x 10(9)/l for WBC and 10 mg/l for CRP. RESULTS: Of the 227 appendicectomized patients, 170 (75%) had acute appendicitis. Sixty-six of the patients were tested on two or more occasions every 4th h. Forty-six of these patients had appendicitis; repetitive tests showed a continuing rise in CRP values but a continuing decrease in WBC. The negative appendicectomy rate among these 66 patients was 30%, which theoretically would have fallen to 19% if patients with normal results had not been subjected to surgery. CONCLUSIONS: Repeated laboratory tests for CRP and WBC should be performed in patients with suspected acute appendicitis requested to stay for further observation. If these test results are normal, the surgeon should preferably refrain from operating but consider other differential diagnoses.

Acute Disease↗
PubMed1994

Hepatic esterification rate of cholesterol and biliary lipids in human obesity.

Obesity is often associated with an increased hepatic secretion rate of cholesterol and saturated gallbladder bile. In order to evaluate the role of hepatic esterification of cholesterol in this phenomenon, we assayed the activity of acyl CoA:cholesterol acyl transferase (ACAT), which catalyzes the esterification of cholesterol, in liver microsomes obtained from 19 morbidly obese patients without gallstones undergoing vertical banded gastroplasty. Gallbladder bile was obtained and analyzed for lipid composition, cholesterol saturation, nucleation time, and occurrence of cholesterol crystals. Fourteen non-obese gallstone-free subjects undergoing cholecystectomy because of suspected polyp or adenomyoma in the gallbladder served as controls. The hepatic content of esterified cholesterol was increased by about 70% in the obese patients (P < 0.05). Still, the mean levels of the ACAT activity were equal in the obese and non-obese patient groups (11 +/- 1 and 11 +/- 2 pmol/min per mg protein, respectively). When exogenous cholesterol was added to the assay system, the activity was increased markedly in both groups. The ACAT activity was higher in obese patients with steatosis of the liver compared with those displaying normal liver morphology (12 +/- 1 vs 8 +/- 1 pmol/min per mg, P < 0.05). Obese patients did not have significantly more saturated gallbladder bile than the non-obese controls (84 +/- 7 and 77 +/- 8%, respectively). They had a normal nucleation time and their gallbladder bile did not contain any cholesterol crystals. We conclude that obese patients without gallstones usually have a normal esterification rate of cholesterol in the liver. Steatosis of the liver was associated with increased ACAT activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Monofilament versus multifilament absorbable sutures for abdominal closure.

This study compares monofilament continuous absorbable sutures with multifilament interrupted absorbable sutures for abdominal closure. Before closure of an abdominal incision, 988 patients were randomized to receive either a monofilament polyglyconate (Maxon) or a multifilament polyglactin 910 (Vicryl) suture. At 1 year after operation, 684 patients (69 per cent) were examined for the presence of incisional hernia, sinus and other wound-healing problems; 179 (18 per cent) had died and 125 (13 per cent) did not attend for follow-up. Incisional hernia occurred in 8 per cent of patients receiving monofilament continuous sutures compared with 6 per cent of those having multifilament interrupted closure (P not significant). Wound dehiscence occurred in 1 per cent of both groups. The mean time for suturing was 7.1 min for monofilament continuous and 8.7 min for multifilament interrupted sutures (P < 0.001). It is concluded that closure of an abdominal incision can be effected by a monofilament continuous absorbable suture more quickly than by multifilament interrupted absorbable sutures without an increased risk of wound dehiscence or incisional hernia.

Abdominal Muscles↗
PubMed1992

Inflammatory response to subcutaneously implanted Marlex and GORE-TEX in massively obese patients.

In both vertical banded gastroplasty and in gastric banding, synthetic bands are used to reinforce the outlet from the pouch to the rest of the stomach. Two materials commonly used for these bands are polypropylene (Marlex) and polytetrafluoroethylene (GORE-TEX). As a measure of their suitability, human inflammatory response to subcutaneous implants was investigated. In a randomized series of 17 superobese patients a patch of GORE-TEX was implanted subcutaneously in one groin under local anaesthesia and Marlex mesh was implanted in the other groin. After about 2 months the implants were exstirpated and investigated in a single blind procedure by an experienced pathologist. Marlex gave a significantly greater chronic inflammatory reaction and fibrosis than GORE-TEX. The foreign body giant cell reaction was, however, significantly greater with GORE-TEX. The possible implications of these results are discussed.

Adult↗
PubMed1992

Aortic valve replacement in octogenarians with aortic stenosis: a case-control study.

OBJECTIVES: This study was designed to compare the results of aortic valve replacement in patients greater than or equal to 80 years old with those in patients 65 to 75 years old. BACKGROUND: Aortic valve replacement may be potentially more complicated and require the use of more resources when performed in octogenarians rather than in younger patients. Few hard data on this possibility are available. METHODS: The study group comprises all 44 patients greater than or equal to 80 years old (mean age 82 years) who underwent aortic valve replacement at our institution between January 1981 and July 1989. A control group of 83 patients with a mean age of 70 years was matched with the study group for gender and approximate date of valve replacement. Before operation, 86% of the older patients versus 36% of the younger patients were in New York Heart Association functional class III or IV (p less than 0.001). Data were retrospectively collected from hospital records and a self-assessment telephone interview was conducted. RESULTS: The early mortality rate was 14% in the older group versus 4% in the younger group (p = 0.045). The duration of respirator support, intensive care and the total duration of the hospital stay did not differ significantly between groups. The incidence of postoperative low cardiac output syndrome was higher in the older group (p = 0.049), but the incidence of late valve-related complications was similar in the two groups. The 2-year survival rate (including data on patients who died early) was 73% in the older group and 90% in the younger group (p = NS). Six months postoperatively all patients but one were in functional class I or II. CONCLUSIONS: Although the patients greater than or equal to 80 years old had a poorer preoperative status than that of younger patients, aortic valve replacement in this group did not require more use of hospital resources and resulted in a clinical improvement comparable to that of younger patients.

Age Factors↗
PubMed1991

Insufficient remodelling of the uterine connective tissue in women with protracted labour.

OBJECTIVE: To investigate the association between a slow progress of labour and insufficient remodelling of the uterine connective tissue. DESIGN: An open comparative study. SETTING: Danderyd Hospital, Department of Obstetrics and Gynaecology, referral centre. SUBJECTS: Eleven women (study group) in oxytocin augmented labour but with an unripe cervix in whom vaginal delivery could not be accomplished and 12 women (normal labour group) in normally progressing spontaneous labour and a favourable cervix but who needed to be delivered by caesarean section due to signs of fetal distress. INTERVENTIONS: At caesarean section tissue specimens were obtained from the fundus, the isthmus and the cervix uteri. MAIN OUTCOME MEASURES: Collagen concentration and extractability, collagenolytic activity expressed as DNP-peptide hydrolytic activity and the concentrations of sulphated glycosaminoglycans (S-GAG) and hyaluronic acid (HA) in the tissue specimens. RESULTS: Statistically significantly higher concentrations and lower extractability of collagen in the isthmus and the cervix uteri was found in women with slow progress of labour compared with those with normal labour. CONCLUSIONS: An insufficient remodelling of the connective tissue in the cervix and isthmus uteri may contribute to slow progress of labour.

Adult↗