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Biomedical subjects

L Thorén

Publications and source records attributed to L Thorén.

At least 19 recordsLinked to original sources
PubMed1989

Lethal horse-riding injuries.

Riding accidents can be of a serious nature. Knowledge of risk factors is of essential value in the prevention of injuries. From the years 1969 through 1982 a series of 53 lethal riding injuries is analysed with reference to the rider, the horse, and the environment. Craniocerebral injuries dominate in this series, indicating the importance of adequately protecting helmets. Among the victims the female sex is dominating before the age of 25 and the males above this age. Older horses are less frequently involved in these accidents than younger ones. A long training period for riders under surveillance of a teacher is of outmost importance. Outdoor riding should be recommended only to experienced riders.

Adolescent↗
PubMed1986

Late results of operation for primary hyperparathyroidism in 441 patients.

The late results of operation for primary hyperparathyroidism (HPT) were analyzed in 441 patients operated on 4 to 27 years earlier (mean follow-up time, 7.7 years). A conservative surgical approach was mainly used, attempting if possible to visualize all four parathyroid glands and extirpate only the enlarged glands. Subtotal resection was performed in patients with hyperplasia. The histopathologic diagnosis was adenoma in 77% and hyperplasia in 18%. In 5% of the patients, the histopathologic classification was uncertain. Hypercalcemia persisted after operation in 8% of all patients. This generally occurred because of an incomplete neck exploration or too limited a resection in the patients with hyperplasia. Recurrent hypercalcemia occurred in 16% of the patients operated on for hyperplasia and was noted 1 to 19 years after surgery. Recurrences were also seen in 3% of the patients with adenomas but not earlier than 9 years after the operation. These findings suggest that primary HPT may even in patients with adenomatous disease, sometimes affect all parathyroid glands. Nevertheless, it was obvious that most of the patients with adenomas would not have benefited from a more radical procedure. On the other hand, it was evidently important to obtain a correct histopathologic diagnosis intraoperatively so that patients with hyperplasia could be identified and adequatley treated.

Adenoma↗
PubMed1985

Relationship between weight reduction and state of malabsorption after jejunoileal bypass for excessive obesity.

A 10-year follow-up study of 30 patients subjected to jejunoileal bypass surgery for obesity is reported. The technique used which resulted in a jejunoileal shunt length of 50-55 cm gave satisfactory weight reduction in 75 per cent of the patients. There were no serious complications. The weight loss occurred essentially during the first 12-18 months, the main cause being defective digestion and malabsorption. In some instances this was supported by initially reduced food consumption. A certain degree of steatorrhoea persists in most cases after 10 years and may be of importance in the maintenance of the new stable weight level.

Adult↗
PubMed1984

Effect of surgical trauma on plasma insulin and somatostatin in response to glucose.

The role of somatostatin for the suppression of insulin release in the early post-traumatic phase was investigated by measurement of somatostatin-like immunoreactivity in plasma during an intravenous glucose tolerance test. In accordance with previous findings the increase of insulin in response to glucose was significantly (p less than 0.001) reduced 2 hours after laparotomy as compared to control subjects. Simultaneously plasma somatostatin was decreased significantly (p less than 0.05). The present data with hormone determinations in peripheral blood does not support the hypothesis that somatostatin, a potent inhibitor of insulin release, mediates the insulin suppression in the early trauma phase.

Adult↗
PubMed1984

Traumatic rupture of the common duct in sclerosing cholangitis.

A women, 52 years, old, with Crohn's disease of the colon treated with colectomy 9 years earlier, got a blunt abdominal trauma in a car accident. At laparotomy two weeks after the accident an isolated transverse rupture of the common hepatic duct was found just below the confluence of the hepatic ducts. The rupture was successfully repaired by a direct anastomosis. Four years later the patient developed attacks of fever and jaundice. A cholangiogram now showed typical signs of sclerosing cholangitis and re-checking of cholangiograms taken after the primary repair revealed that the disease existed already at that time. The cholangitis is supposed to be a contributing factor to the rupture.

Cholangiography↗
PubMed1982

Carcinoma of the junction of the main hepatic ducts.

Patients with carcinoma of the hepatic duct junction often present the surgeon with a difficult problem. If at all possible radical surgery may be performed either as a resection of the tumour and an anastomosis according to Roux-en-Y or a resection of the left or right hepatic lobe together with the obliterated hepatic duct or ducts. The present series consists of 17 patients treated for cancer of the hepatic duct junction during the period 1965-1974 with a follow-up period of at least five years. The surgical treatment given included a radical procedure in 8 cases, a palliative procedure in 7 cases and in 2 cases surgery of the hepatic ducts was not possible. Radical procedures included 4 patients with a resection of the left hepatic lobe and 4 patients with resection of the left and right hepatic ducts and anastomosis according to Roux. A mean survival time of 22.8 months was reached when a radical operation was attempted with a longest survival time of 8 years. A palliative procedure gave a mean survival time of 2.0 months. These figures indicate that a careful selection of patients for an attempt of radical surgery could be made since removal of the tumour gives a more effective palliation, often a longer survival time and an improvement of quality of life.

Adult↗
PubMed1981

Serum lipoprotein lipid and apolipoprotein concentrations in grossly obese patients before and after jejuno-ileal shunt operation.

Fourteen grossly obese patients were studied before and 2, 6, 12 and 24 months after jejuno-ileal bypass. The major weight loss occurred during the first 6 months while there was no significant change of the mean body weight during the last 12 months of the study. During the initial period of pronounced weight loss there were significant reductions of all lipoprotein classes, e.g. at 2 months the very low density lipoprotein triglycerides had decreased by 41% (P less than 0.01), the low density lipoprotein cholesterol by 42% (P less than 0.001), the high density lipoprotein cholesterol by 27% (P less than 0.001) and the serum apolipoprotein B, A-I and A-II concentrations by 30% (P less than 0.001), 17% (P less than 0.001) and 27% (P less than 0.01) respectively. The fractional removal rate (K2) at the intravenous fat tolerance test had increased by 38% (P less than 0.01), indicating an increased removal capacity of triglyceride-rich lipoproteins. At 24 months the very low density lipoprotein triglycerides, the low density lipoprotein cholesterol and the apolipoprotein B concentration remained reduced by 28% (P less than 0.05), 48% (P less than 0.001) and 35% (P less than 0.001) respectively. The intravenous fat tolerance test K2 remained significantly increased by 44% (P less than 0.05). However, the high density lipoprotein cholesterol and the apolipoprotein A-I and A-II concentrations had successively increased again to preoperative levels. The low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio was decreased by 44% (P less than 0.001) and the apolipoprotein A-I/apolipoprotein B ratio had increased by 74% (P less than 0.001), both changes presumably beneficial in regard of atherogenicity. The apolipoprotein A-I/high density lipoprotein cholesterol and apolipoprotein B/low density lipoprotein cholesterol ratios had increased by 23% (P less than 0.001) and 28% (P less than 0.001) respectively. The data indicate that the reduction of high density lipoprotein may be a transient phenomenon during the initial period of weight loss but that definite changes occur in the high density lipoprotein and low density lipoprotein composition which are apparent also 2 years after surgery.

Adolescent↗
PubMed1981

Pathophysiology of massive trauma with therapeutic implications.

In addition to its local effects, severe trauma has several consequences for the whole organism. Partly, these are hormonal, humoral and neural regulatory mechanisms - negative feedback mechanisms to regain homeostasis, a balance of the "milieu intérieur". Blood loss and disturbances in the fluid compartments is one of the central pathological features. The shock period is accompanied by mobilization of defense mechanisms and energy. The length and extent of of the catabolic phase depends on the extent of the injury, the effectiveness of the therapeutic efforts and the disturbances of organ and system functions. Repair proceeds gradually aiming at anatomical and functional restitution.

Acute Kidney Injury↗
PubMed1981

Parietal cell vagotomy and truncal vagotomy as treatment of duodenal ulcer. A prospective randomized trial.

In a prospective randomized trial parietal cell vagotomy (PCV) was compared with truncal vagotomy with drainage (TV) in the treatment of duodenal ulcer. The material consists of 106 patients, 50 TV and 56 PCV. Basal and maximal acid output (BAO, MAO) were measured preoperatively, 6 weeks and 12 months postoperatively. The clinical results were judged from a modified Visick grading system 1-6 years postoperatively. BAO 6 weeks after PCV was reduced with 60% in average and 12 months postoperatively with 45%. After TV the BAO was reduced with 53% 6 weeks postoperatively and 34% 12 months postoperatively. MAO was reduced with 47% 6 weeks after PCV and with 31% 12 months postoperatively. After TV the reduction of MAO was 50% and 44%, respectively. After PCV 62% of the patients were insulin positive at the first postoperative examination and 78% one year later. After TV 46% of the patients had a positive insulin test at the first postoperative examination and 50% one year later. In the PCV group 9 patients (16%) have got recurrences during the 1-6 years observation time, in the TV group there were 4 recurrences (8%). In the PCV group 24% of the patients with pyloric or prepyloric ulcer got recurrences and 13% of the patients with duodenal ulcer. In the TV group the number of recurrences was 13% and 6%, respectively. At the modified Visick classification 71% of the patients in the PCV group were graded as I and II, 4% as III and 25% graded as IV. After TV 83% of the patients were graded as I and II, 4% as III and 13% graded as IV. The results from this study do not allow us to recommend PCV before TV and it should be seriously questioned if it shall at all be performed on prepyloric ulcers.

Adult↗
PubMed1980

Biliary tract carcinoma.

A series of 127 patients treated for cancer of the biliary tract during the period 1965-1974 was studied with a follow-up period of at least five years. The mean age was 66 years and the female:male ratio was 3:1. An early diagnosis of biliary tract carcinoma is difficult and the prognosis unfavourable although not hopeless. The surgical treatment given in the present series included a radical approach whenever possible. In the total series 56 patients died within a month, 24 lived for more than one year, 9 longer than three years and 5 longer than five years and 3 are still alive. A mean survival time of 25.6 months was reached when a radical operation was attempted while a palliative procedure gave a mean survival time of 5.5 months. These figures indicated that a careful selection of patients for an attempt of radical surgery should be done since removal of the tumour gives a more effective palliation, often a longer survival time, an improvement of quality of live and in a few patients cure.

Adenocarcinoma↗
PubMed1980

The dextrans--clinical data.

The use of dextrans in clinical practice are mainly based on the following effects: 1. Plasma volume effects 2. Flow Promotion 3. Antithrombotic effects. The dextrans are the only plasma volume substitute with the antithrombotic effect but this discussion will only deal with their effects on plasma volume and flow. The effect on plasma volume--the colloid supported intravascular volume--can be calculated as ml of water held in circulation per gram circulating colloid--for dextran 70 around 20 ml/g, for albumin 18 ml/g and for plasma protein 12-13 ml/g. After infusion of a plasma volume substitute the volume effect depends on dose injected, molecular weight distribution, rate of disappearance from the intravascular department mainly via the kidneys. The clinical experience of a reliable plasma volume expansion can be demonstrated in animal experiments comparing different infusion fluids. The effect on erythrocyte aggregation depends on kind of substance and molecular weight distribution. The flow promoting effect is mainly due to restoration of plasma volume but also related to hemodilution and aggregation. The vasoconstriction seen in shock can be counteracted essentially with colloid supported plasma volume expansion. The supposed influence of the dextrans on the kidney function in some clinical cases has been investigated experimentally.

Blood Circulation↗