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Biomedical subjects

L Granström

Publications and source records attributed to L Granström.

At least 55 records · Page 3Linked to original sources
PubMed1991

Jejunoileal Bypass Operations With a Side-to-side Anastomosis in the Treatment of Morbid Obesity.

In order to avoid a stagnant loop syndrome in intestinal bypass operations for morbid obesity, we have tried a jejunoileal bypass with a side-to-side anastomosis in a pilot study. Seven patients were operated on with this method, which resulted in a very high incidence of liver damage. The study puts a question mark to the blind loop syndrome as an etiological factor in producing liver damage.

Journal Article↗
PubMed1991

Preinductive cervical ripening with PgE2 gel in term pregnant women with ultrasonically diagnosed intra-uterine growth-retarded fetuses.

Intra-uterine growth retardation (IUGR), often combined with other pregnancy-related complications, constitutes a rather common indication for labor induction. The objective of this prospective study was to evaluate a strict intracervical application of 0.5 mg PgE2 in gel for cervical ripening and labor induction. Eighty term pregnant women with an ultrasonically diagnosed IUGR (less than -2 SD) and an unripe cervix were given PgE2-gel. The main indication for labor induction was IUGR, but 26 women had other complications. IUGR was verified at delivery in 50 women (study group), whereas 30 women (control group) gave birth to infants of normal birth weight (greater than -2 SD). The cervical ripening effect did not differ between the groups. In the study group, 19 nulliparous and 15 parous women out of 50 had a favorable cervix after 12 h and were delivered within 24 h of gel application. The corresponding result for the control group was 11 nulliparous and 8 parous women out of 30. Failed induction was registered in 2 and one woman respectively. On the other hand, the number of instrumental deliveries was greater in the study group, 11 caesarean sections (CS) and seven ventouses, compared with one CS and three ventouses in the control group (p less than 0.05). The frequency of operative deliveries for fetal distress (ODFD) was higher among the women with verified IUGR (14/50) than in the controls, where the corresponding figure was 3/30. No side effects were observed. We conclude that strict intracervical application of 0.5 mg PgE2 is a safe and effective method for cervical ripening and labor induction in women with IUGR.

Adult↗
PubMed1991

The effect of omeprazole and ranitidine on ulcer healing, relief of symptoms, and incidence of adverse events in the treatment of duodenal ulcer patients.

In a Swedish double-blind multicenter study involving 143 patients, the new proton pump inhibitor omeprazole (30 mg taken as a single morning dose) was compared with ranitidine (400 mg b.i.d.). Clinical assessment and laboratory investigations were carried out at 2 and 4 weeks, and again at 6 weeks if patients had not healed earlier. Endoscopy was repeated at two-weekly intervals until the ulcer was healed. The patients in the two treatment groups were well matched prior to treatment. There was a higher ulcer healing rate in the omeprazole group (70%) than in the ranitidine group (55%) after two weeks of treatment. This difference reached statistical significance in 128 patients adhering to the protocol as shown by a logit model analysis with drug, ulcer size and smoking as the prognostic factors (p = 0.04). There were no major differences between the two treatment groups in terms of symptomatic relief. Both drugs were generally well tolerated, and the number of adverse events in the two treatment groups were similar. After healing, 127 patients entered a follow-up study, with endoscopy either after 6 months or on recurrence of symptoms. There was no significant difference between the two treatment groups, with the relapse frequency within 6 months being 39% in the omeprazole group and 47% in the ranitidine group. These results, with a 15 percentage points higher ulcer healing rate for omeprazole as compared with H2-receptor antagonists after two weeks, are in accordance with results reported in other studies.

Duodenal Ulcer↗
PubMed1990

Myometrial activity after local application of prostaglandin E2 for cervical ripening and term labor induction.

Twelve pregnant women at term with unfavorable cervices (less than or equal to 5 points according to Bishop score) were given prostaglandin E2 for cervical priming and labor induction. Prostaglandin E2 was given in the following manner: 0.5 mg in gel strictly intracervically (n = 4), extraamniotically (n = 4), or prostaglandin E2 (4 mg) in gel vaginally (n = 4). The myometrial activity was registered over a period of 30 minutes before and at least 3 hours after gel application by means of an extraamniotic microtransducer catheter. After both extraamniotic and vaginal gel application, myometrial activity was significantly increased compared with intracervical application. All the women had favorable cervical states 6 hours after treatment and were delivered vaginally within 24 hours. All infants were delivered in good condition with 1-minute Apgar scores greater than 7. From these results we conclude that proper intracervical prostaglandin E2 gel application, in contrast to extraamniotic or vaginal application, induces cervical ripening without significant myometrial activity. Because careful intracervical application appears to avoid or minimize the risks of myometrial hyperstimulation, this technique should be considered particularly in women with unfavorable cervices and delicate fetuses.

Administration, Intravaginal↗
PubMed1990

Fetal growth retardation after gastric banding.

A 35-year-old woman became pregnant 15 months after gastric banding, during which time she lost 55 kg in weight. During the third trimester, severe vomiting was noted and she lost a further 6 kg. Ultrasound examination showed oligohydramnions and fetal growth retardation of 38%. Enteral nutrition was given until delivery and ultrasound verified normalization of the oligohydramnions and weight gain for the fetus. The woman was delivered by cesarean section of a female infant with birthweight 2,470 g. It is concluded that special care must be taken with regard to the nutritional status of pregnant women who have previously been operated on with gastric procedures for obesity, in order to diminish the risk of fetal growth retardation. Ultrasound examinations should be performed on wide indications and enteral nutrition must start immediately once fetal growth retardation is discovered.

Adult↗
PubMed1989

Changes in the connective tissue of corpus and cervix uteri during ripening and labour in term pregnancy.

The composition of the connective tissue of human cervix and corpus uteri was studied in tissue specimens from seven nonpregnant women and 14 pregnant women, delivered at term by section, to examine spontaneous cervical ripening and labour-induced changes in both the uterine and the cervical connective tissue. The main finding in both the cervix and the corpus was a large (40-60%) decrease of the collagen concentration. The collagen extractability, obtained by pepsin digestion, was increased twofold, suggesting a change of the organization of the collagen fibrils. This reorganization process could also be demonstrated by a large increase of the collagenolytic activity demonstrated with an artificial DNP-peptide substrate. The concentrations of sulphated glycosaminoglycans was lower in pregnant women than in non-pregnant women. The results show that both the cervix and the corpus uteri contain substantial amounts of connective tissue components (collagen, sulphated glycosaminoglycans and hyaluronic acid) and that during ripening, reconstruction of the connective tissue components occurs in both sites. This indicates that the cervical state reflects that of the myometrium.

Adolescent↗
PubMed1989

Intravenous infusion of 15 methyl-prostaglandin F2 alpha (Prostinfenem) in women with heavy post-partum hemorrhage.

Post-partum hemorrhage is a serious complication in obstetric practice. The aim of this study was to investigate, in vivo, the effects of 15 methyl-prostaglandin F2 alpha (Prostinfenem, Upjohn, Sweden) on uterine activity and hemorrhage. Twenty-seven women were included in the study and, in accordance with our clinical routine, all were given oxytocin (10 IE Syntocinon) intramuscularly immediately after delivery. In cases of heavy bleeding and signs of uterine atony, ethylergometrine (0.2 mg Methergin) and oxytocin (40 i.e. Syntocinon in 500 ml, 5.5% glucose) were administered intravenously. If this therapy failed, the woman was given an intravenous infusion of 15-methyl-prostaglandin F2 alpha (0.25 mg Prostinfenom, in 500 ml, 5.5% glucose). Myometrial activity was quantitated in 5 women by a micro-transducer introduced into the uterine cavity. The treatment resulted in a contracted uterus and cessation of bleeding within 12.5 min (mean). The intra-uterine pressure registered a prompt effect regarding both amplitude and frequency of uterine contractions.

Adult↗
PubMed1989

Laboratory tests in patients with suspected acute appendicitis.

The clinical usefulness of preoperative determination of total and differential white blood cell count and C-reactive protein was studied in 113 patients undergoing emergency appendectomy for suspected acute appendicitis. The diagnosis was confirmed in 86 (76%) of the patients. In all 86 cases at least one of the three laboratory tests gave an abnormal result. The highest incidence of abnormal results was found in the most advanced stages of inflammatory reaction in the appendix. In nine of the 27 patients with histologically normal appendix all three laboratory parameters were normal. The "negative appendectomy rate" would have fallen from 24% to 16% in this study if the patients with negative results in all three tests had not been operated on.

Acute Disease↗
PubMed1989

Elevated plasma levels of oxytocin in obese subjects before and after gastric banding.

Impaired glucose tolerance and hyperinsulinaemia are common features of obesity. Since oxytocin has been shown to influence glucose metabolism and insulin secretion, the objective of the present study was to investigate whether the plasma level of oxytocin is elevated in obese subjects and if so, whether it is affected by weight reduction following gastric banding. Repeated blood samples were collected in connection with ingestion of a liquid test meal from subjects weighing about 130 kg. Normal weight subjects were tested likewise. Further tests were performed on obese subjects 6 months after operation with gastric banding and a subsequent weight reduction of about 30 kg. Plasma levels of oxytocin were measured by radioimmunoassay. It was found that plasma levels of oxytocin were 4-fold higher in the obese subjects when compared to the control subjects. Analysis with high performance liquid chromatography demonstrated that the oxytocin-like material, as determined by radioimmunoassay, in extracted plasma from one obese subject coeluted with synthetic oxytocin standard. Ingestion of a test meal did not seem to influence oxytocin levels. The mean oxytocin level was equally elevated in male and female obese subjects. Following operation oxytocin levels decreased significantly, but were still significantly higher than in the control subjects. The mechanism behind the hyperoxytocinaemia and possible consequence of it remain obscure.

Female↗
PubMed1988

Serum gastrin, insulin and somatostatin levels in normal and obese subjects before and after gastric banding.

The postprandial secretion of insulin, gastrin and somatostatin was studied in 23 extremely obese subjects and nine normal-weight controls after a liquid test meal. Apart from a significantly higher insulin level in the obese group, no significant intergroup difference was found. The effect of weight loss on the same hormones was studied in 18 patients 6 months after gastric banding. The mean weight loss during this period was 33 +/- 2.1 (SEM) kg. There was significant decrease in postprandial insulin secretion after gastric banding, but neither gastrin nor somatostatin levels were altered.

Adult↗
PubMed1987

Cervical priming and labor induction with vaginal application of 3 mg PGE2 in suppositories in term pregnant women with premature rupture of amniotic membranes and unfavorable cervix.

Sixty-one term pregnant women, 29 nulliparous (Group A) and 32 multiparous (Group B) with unfavorable cervix and premature rupture of the membranes (PROM) were given 3 mg PGE2 in suppository form for cervical ripening and labor induction. Five hours after starting the treatment, 12 women of the 29 in Group A and 21 of the 31 in Group B had a favorable cervix and established labor. The remaining 17 nulliparae and 11 multiparae still had an unfavorable cervix and were then given another PGE2 suppository. Until the next morning, i.e. within 24 h, 19 nulliparous and 22 multiparous women gave birth whereas a further 5 nulliparous women who now had favorable cervix but no uterine contractions were delivered after stimulation with intravenous oxytocin. The remaining undelivered women were given another PGE2 suppository. With or without additional oxytocin stimulation, all but 2 multiparous women could be delivered within a further 12 hours. The total number of instrumental deliveries in Group A was 2 caesarean sections due to disproportion (7%) and 5 ventouses. In Group B, 3 caesarean sections (9%) had to be carried out, one due to fetal distress and 2 due to failed induction. From the results of this study we conclude that vaginal application of 3 mg PGE2 in suppository form can be used to induce labor in patients with PROM and unripe cervix. However, when the results are compared with those obtained in previous studies after application of PGE2 in gel, the latter technique seems preferable.

Cervix Uteri↗
PubMed1987

Technical complications and related reoperations after gastric banding.

Seventy-two patients who underwent gastric banding for extreme obesity were followed for a mean of 30 (range 12-54) months. The mean weight loss after 1 year was 41 kg. About two-thirds of the patients had only minor complaints postoperatively, but the others had complications, some of which were serious. Two patients died. Complications related to the banding technique necessitated 33 reoperations in 22 patients. The most common cause of reoperation/complication was functional stenosis of the upper pouch outlet, but only 3 of 22 revisional operations were successful. Reduction in band tension resulted in fewer reoperations but also less weight loss. The incidence of complications and the poor outcome of revision indicate that gastric banding should still be regarded as an experimental operation. Peroperative measurement of all technical details and careful and frequent follow-up examination are necessary in the search for an optimal technical procedure, giving good weight loss with a minimum of complications.

Adult↗
PubMed1987

Gastric acid secretion in extremely obese subjects before and after gastric banding.

The gastric acid secretion was studied in 17 extremely obese patients after injection of synthetic gastrin (Peptavlon). The mean basal acid output (BAO) and the peak acid output (PAO) were both within normal range. Positive correlation was found between PAO and body weight. Gastric banding was performed as treatment of the obesity, and the gastric acid secretion was studied in the proximal and the distal pouch after a mean postoperative interval of 8 (range 4-20) weeks. BAO was similar after banding, but PAO was significantly decreased (from 26.3 +/- 3.6 to 16.2 +/- 2.2 mmol/h). PAO and BAO were almost identical in the two pouches, despite great difference in their size.

Adult↗
PubMed1987

Comparison between subjective and objective estimates of upper pouch volume at gastric banding for obesity.

Small size of the upper pouch has been considered mandatory for good weight loss after different gastric operations for extreme obesity. In most published series the estimates of upper pouch size seem to have been subjective. The present report concerns gastric banding in 18 patients, with standardized objective measurement of the upper pouch made after subjective estimation independently by two bariatrically trained surgeons. The subjective determination resulted in statistically significant underestimation compared with the objective procedure. For adequate evaluation of the surgical method, therefore, it is important to measure the pouch size objectively.

Adult↗
PubMed1987

Weight loss and some metabolic consequences of gastric banding with different band tension.

The results of gastric banding for obesity were studied in 72 patients. The tension of the band around the stomach was successively decreased because of vomiting. The change resulted in less problems with vomiting and fewer reoperations, but also less weight loss. Statistically significant correlation was found between the Broca index before gastric banding and a year later. The superobese patients (greater than 100% overweight) had significant residual obesity when they reached stable body weight after about a year. Some metabolic changes were found postoperatively, e.g. improved results of liver function tests, reduced serum triglycerides, commonly sideropenia and occasionally hypokalemia.

Adult↗
PubMed1986

Tissue reaction to polypropylene and polyester in obese patients.

Local tissue reaction was examined after subcutaneous implantation for 8 wk of small pieces of Marlex (polypropylene) and Dacron (polyester) in 11 extremely obese patients. Dacron gave a stronger chronic inflammatory reaction in 7 out of 11 patients, and a stronger foreign body giant cell reaction in all of them: Marlex is therefore perhaps more suitable than Dacron as a reinforcement band in gastric surgery for obesity. At reoperations due to complications after gastric banding the tissue reaction in the omentum which covered the band, was examined in 9 patients. No major difference in tissue reaction in the omentum compared to that in subcutaneous fat was found. None of the reoperations was caused by too strong a tissue reaction to the reinforcement band i.e. Marlex in 8 patients and Gore-tex (Teflon) in one patient.

Biocompatible Materials↗