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Biomedical subjects

L Hultén

Publications and source records attributed to L Hultén.

At least 19 recordsLinked to original sources
PubMed1992

Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment.

The incidence and prognosis of anal fistulas were investigated in a prospective study comprising 136 patients operated on for Crohn's disease. The incidence of anal fistulas was 27 of 136 (20%), in patients with classical disease 12 of 68 (18%), and in those with Crohn's colitis 15 of 68 (22%). A fistula preceded the intestinal manifestation of the disease in 6 patients. At the time of diagnosis of Crohn's disease anal fistulas were observed in 19 cases, including 3 of the 6 with early onset which had resisted treatment and remained active. Five patients developed anal lesions during the course of the disease, all but 2 in temporal relationship to an intestinal recurrence. Of the 27 patients with anal fistulas, 11 were of the low-anal type, whereas 14 were anorectal. Conventional laying open of the fistula was undertaken in all patients with classical Crohn's disease in close conjunction with resection of the intestinal disease. On local surgical treatment 10 of 12 (89%) healed with preservation of continence. Four recurrent fistulas occurring in conjunction with intestinal recurrence also healed uneventfully. Laying open was undertaken in 11 of the 15 patients with colitis. Healing was obtained in only 4 of these patients. In the remaining 4 severe colitis indicated immediate proctocolectomy. Occurrence of fistulas involved a significant delay in perineal healing after proctectomy. It is concluded that traditional laying open of an anal fistula in patients with classical Crohn's disease is followed by high rate of uneventful healing. In contrast, local surgical treatment of anal fistulas complicating Crohn's colitis is usually unsuccessful.(ABSTRACT TRUNCATED AT 250 WORDS)

Crohn Disease↗
PubMed1992

The failing pelvic pouch conversion to continent ileostomy.

Excision of a failing pelvic pouch is often a great disappointment for the patient. It is also an unfortunate decision considering that a significant length of terminal ileum is sacrificed. Transformation of the pouch to a continent ileostomy is an alternative. Five patients with a malfunctioning pelvic pouch have had their pouch converted to a continent ileostomy. The operative technique is described.

Adult↗
PubMed1991

Radiological study of changes in the pelvis in women following proctocolectomy.

The vagina, uterus and adnexa of 21 women who had a proctocolectomy for ulcerative colitis or Crohn's colitis were examined with vaginography and hysterosalpinography. Six healthy women were used as controls. A characteristic post-operative deformation of the adnexa and the vagina was demonstrated. In 17 of 21 women the fallopian tube anatomy was pathological, in four cases with total obstruction. These abnormalities explain why vaginal discharge, dyspareunia and involuntary sterility are common complaints in women after this type of surgery.

Adnexa Uteri↗
PubMed1991

The effects of atropine or benzilonium on pelvic pouch and anal sphincter functions.

Anticholinergic drugs are used on an empirical basis for treatment of functional disturbances after restorative proctocolectomy, but their mode of action on ileal pouch performance is mainly unknown. We studied the acute effects of atropine or benzilonium on pouch characteristics and anal sphincter function in 20 patients with a pelvic pouch. Pouch volume was increased by 27% by atropine at distension with 20 cm H2O (p less than 0.01). Benzilonium tended to have a similar effect, but the changes did not reach statistical significance (p = 0.06). Pouch contractility, as reflected by volume fluctuations and pressure changes during distension, was almost abolished by both drugs. Sensory thresholds for sense of filling and, particularly, urge were raised. Resting anal pressure was slightly lowered, whereas no significant effect was found on maximal squeeze pressure. In conclusion, anticholinergics appear to have specific properties of action on small-intestinal reservoirs, constituting possible explanations for the empirically observed beneficial effects of anticholinergic treatment of functional disturbances after restorative proctocolectomy.

Adult↗
PubMed1991

Sodium and potassium excretion in patients with ileostomies.

The output of sodium and potassium from urine and ileostomy was investigated in 35 healthy patients with ileostomies; 17 had undergone proctocolectomy for ulcerative colitis and 18 for Crohn's colitis. Fifteen of the patients with Crohn's disease had also had small bowel resections, varying from 15 to 46% of the original bowel length. The patients were investigated at home because most studies of sodium and water balance in patients with ileostomies have been done in hospital wards, which may not reflect actual conditions. Mean (SD) ileostomy output was 565 (152) ml in patients with ulcerative colitis and 1,267 (540) ml in patients with Crohn's disease. The intrapatient variation was limited, whereas the interpatient variation was significant and correlated with the length of small bowel resected. The sodium concentration in the ileostomy discharge was 110 (9.2) mmol/l and did not change consistently with ileostomy volume. The potassium concentration was 10 (2.1) mmol/l. There was a significant inverse correlation between daily ileostomy sodium output and urinary sodium concentration (r = -0.44, p less than 0.01), and a significant correlation between the daily output of sodium in ileostomy contents and the sodium:potassium ratio in urine. We conclude that patients with ileostomies are at risk of sodium and water depletion, particularly those who have had small bowel resections. Increased sodium output from the ileostomy is associated with a reduction in the sodium:potassium ratio in the urine. To screen patients at risk, an estimate of the sodium balance can be made by measuring sodium and potassium concentrations in a single specimen of urine.

Adult↗
PubMed1990

Fecal excretion of radiolabeled (51CrCl3) proteins in patients with Crohn's disease.

Intestinal leakage of plasma proteins was studied in 69 patients with Crohn's disease. In vivo labeling of plasma proteins was performed by intravenous injection of trace amounts of 51CrCl3. Complete fecal collection was done for 5 days, carefully avoiding contamination with urine. The daily fecal radioactivity was measured in a whole-body counter and expressed as a percentage of given dose. In patients with a classic localization of the disease the mean fecal excretion of radiolabeled proteins was 2.8% (range, 0.8-5.5%). The excretion was significantly higher in patients with extensive ileojejunal involvement (8.8%; 4.3-14.0%) and in patients with a total colitis (5.5%; 2.0-8.2%) but not different from that in patients with prestomal recurrent ileal disease (3.5%; 1.6-5.3%). A close correlation was found between fecal excretion of 51Cr and extent of the small-intestinal disease as measured at laparotomy (r = 0.86, p less than 0.001). A highly significant inverse relationship was also demonstrated between fecal protein excretion and serum albumin concentration in patients without septic complications of the disease (r = -0.57, p less than 0.001). A pre-existing septic complication made the patients hypoalbuminemic despite limited intestinal loss of protein. It is concluded that estimation of intestinal protein loss is a sensitive and simple test for assessment of the extent of the small-intestinal involvement in patients with Crohn's disease. The test may be of value in patients with unclear radiologic findings and in patients with hypoalbuminemia of unknown cause.

Adolescent↗
PubMed1979

Absorption studies in patients six to 10 years after construction of ileostomy reservoirs.

The absorption of fat, bile salts, and vitamin B12 was studied in 14 proctocolectomised patients six to 10 years after construction of a continent ileostomy. All patients were in excellent health and displayed no signs of malnutrition. Schilling test disclosed subnormal absorption of vitamin B12 in one patient and borderline values in five. Faecal loss of bile acid was increased in 12 patients and fat malabsorption occurred in two. Except for slightly pathological liver tests in two patients, routine laboratory tests, including plasma concentration of vitamin B12 and folic acid, were normal. There were no signs of sodium or potassium depletion.

Adult↗
PubMed1979

Faecal excretion of intravenously injected 14C-cholic acid in patients with conventional ileostomy and in patients with continent ileostomy reservoir.

Bile salt absorption, as determined by the faecal excretion in i.v. injected 14C-cholic acid (FBS) was studied in 13 ileostomy patients before and after conversion to Kock's continent ileostomy reservoir. The result was compared with that obtained in 8 ileostomy patients in whom about 50 cm of the terminal ileum has also been removed. As compared with 16 healthy controls, FBS was moderately increased in the conventional ileostomy patients, but still within normal limits. After conversion to ileostomy reservoir all patients had pathological FBS, although less severe than in the ileostomy patients with ileal resection. Bacterial contamination probably contributes more than the structural mucosal changes to the bile malabsorption in the pouch, whereas reduced mucosal surface and short small-intestinal transit time are the main causes of malabsorption in ileostomy patients in whom an appreciable amount of the terminal ileum has been resected.

Adult↗
PubMed1979

Clinical and morphological characteristics of colitis carcinoma and colorectal carcinoma in young people.

Two series of young patients (less than 40 years of age) with colorectal carcinoma (22 idiopathic carcinomas and 25 carcinomas complicating ulcerative proctocolitis), well matched for age and sex, were compared with regard to clinical features, tumour morphology and stage, and ultimate outcome after surgery. The cure rate in both series was low. Although a failure to diagnose colitis carcinoma accurately at an early stage might have contributed to the poor results, such a delay could hardly be responsible for the bad prognosis in patients with idiopathic carcinoma. The vast majority of the patients in both groups studied had highly malignant and/or mucoid adenocarcinoma, and surgery was palliative in about 40% of the patients in both series, owing to widespread dissemination. The general impression gained from this study of factors of histologic grade of malignancy, extent of spread, and survival rate was that colorectal carcinomas in the young, irrespective of being idiopathic or complicating ulcerative colitis, run a rapid course and have a gloomy prognosis. The outloook depends largely on the biologic characteristics of the tumours concerned. The results support previous statements that prophylactic surgery is justified in patients with long-standing ulcerative colitis with total involvement of the colon, particularly in the young. Regrettably, patients with idiopathic carcinoma will not have this chance.

Adenocarcinoma, Mucinous↗
PubMed1978

Cancer risk in extensive ulcerative colitis.

Two hundred thirty-four patients with extensive ulcerative colitis from the city of Göteborg, Sweden have been followed up and the cumulative risk of development of cancer of the large bowel was estimated. These patients constitute all persons in this region who developed an extensive ulcerative colitis between 1951 and 1974. All patients were followed up until December 1975. The mean observation time was 8.5 years, median value six years. Fifteen patients developed carcinoma of the large bowel. Five of the 15 patients were still alive in December 1975. The expected number of colorectal carcinomas in a matched reference group was 0.49. The cumulative incidence of carcinoma 25 years after the onset of colitis for the whole group of patients was 34% and for those who developed the disease before 25 years of age it was 43%.

Adult↗
PubMed1978

Determination of the faecal excretion of labelled bile salts after i.v. administration of 14C-cholic acid. An evaluation of the bile salt malabsorption before and after surgery in patients with Crohn's disease.

By measuring total faecal radioactivity, correlated to 24-hour enterohepatic circulation, following i.v. administration of 14C-cholic acid, bile salt malabsorption was evaluated before and/or after surgery in 80 patients with Crohn's disease localized to the ileum and/or the colon and the results related to the length of ileum diseased or resected. Before operation bile salt malabsorption was observed only in patients with inflammation of the terminal ileum, but no significant correlation was found between bile salt excretion and the extent of ileal disease. In patients subjected to ileal resection with sacrifice of the ileocaecal valve, bile salt malabsorption correlated strongly to the length of ileum resected. This correlation was about the same in ileostomy patients and in patients subjected to restorative operation. We concluded that determination of 14C in faeces is a more sensitive test than the Schilling test and the faecal fat excretion test in reflecting ileal dysfunction, at least in patients with ileal resections.

Adult↗
PubMed1978

Malabsorption of fat and vitamin B12 before and after intestinal resection for Crohn's disease.

Intestinal absorption of fat and vitamin B12 was studied prospectively in 136 patients with Crohn's disease localized to the ileum and/or the colon. Fecal fat was measured in 3-day periods on a high fat diet, and vitamin B12 absorption was assessed by the Schilling test. When related to the extent of the ileal disease there was a poor correlation to both fecal fat excretion and the result from the Schilling tests, but an exponential and highly significant correlation was found between the results of both tests and the length of the resected ileal segment. Accepting a change in either direction not exceeding 10% of the preoperative test value as unchanged, three-fifths of the patients deteriorated and one-fifth improved in fat-absorption, whereas half the patients deteriorated and one-third improved in vitamin-B12 absorption after surgery. When related to the length of the ileum resected, the test results were about the same in patients subjected to a restorative procedure sparing the major part of the colon and in ileostomy patients. Absorption of fat and vitamin B12 did not change with time elapsing from operation, indicating that there were no compensatory mechanisms as regards absorption of these substances.

Adult↗
PubMed1978

Urinary oxalate excretion related to ileocolic surgery in patients with Crohn's disease.

Urinary oxalate excretion was studied in healthy subjects and before and after surgery in patients with Crohn's disease. Urinary oxalate excretion in relation to the length of diseased or resected ileal segment in patients subjected to restorative and colectomy procedures, as well as in relation to faecal excretion of fat and bile salts and to urinary excretion of vitamin B12 and calcium, was also studied. The studies were performed in patients on a free diet or standard hospital diet and on a high-oxalate and/or high-fat diet. When patients subjected to ileal resection in conjunction with minor colonic resection were studied on a high-oxalate diet, urinary oxalate excretion increased with length of ileum resected and correlated with faecal fat excretion and urinary excretion of vitamin B12 but not with faecal excretion of bile salts. Increasing the dietary fat intake in these patients further increased urinary oxalate excretion. Although urinary oxalate excretion increased somewhat in colectomized patients on a high-oxalate diet, indicating an increased absorption of dietary oxalate, this increase showed no correlation either to faecal fat or bile salt excretion, or to urinary excretion of vitamin B12. The result are consistent with the "solubility theory". A diet low in fat and oxalate and high in calcium is recommended in patients with hyperoxaluria.

Adult↗