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Biomedical subjects

L Thorén

Publications and source records attributed to L Thorén.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1980

Clinical effects of parathyroid surgery in normocalcaemic patients with recurrent renal stones.

Among 52 patients with recurrent renal calcium stones submitted for neck exploration 12 had adenomas, 23 hyperplasia and only 17 histologically normal parathyroid glands. These patients were selected for surgery despite a normal mean value of the total serum calcium concentration because they had, in most cases, indirect evidence of parathyroid hyperfunction such as intermittent hypercalcaemia (in 25 of the patients), hypercalciuria or a pathological response to calcium infusion. It is suggested that the patients with adenomas suffered from primary hyperparathyroidism (HPT), which however did not cause persisting hypercalcaemia. It seems likely that parathyroid hyperplasia either was a mild or an early form of primary HPT or secondary to increased calcium losses. In this study, no single laboratory feature could clearly separate the different groups. None of the patients with adenomas formed any new stone during follow-up (2-7 years) and also 40% of those with hyperplasia appeared to experience benefit from surgery. This benefit was more common in those with occasionally raised serum calcium values. In cases with borderline hypercalcaemia HPT is common and is cured by parathyroidectomy. However, in clinical practice the differential diagnosis may be difficult. In cases without firm evidence of HPT a conservative approach is favoured. Thiazides appear to reduce the stone recurrence rate in most euparathyroid patients and will probably help to unmask borderline HPT in recurrent renal stone formers.

Adenoma↗
PubMed1978

[Vein reconstruction in lower limb injuries (author's transl)].

Reconstructive venous surgery is essential in lower limb injuries to avoid circulatory insufficiency when the main vein is severed. The repair requires a vein graft with adequate lumen--two segments of the saphenous vein are slit open and sutured together. A technique for atraumatic preparation of this composite graft is described. A peripheral temporary A-V fistula is advocated to prevent thrombosis of the graft.

Adult↗
PubMed1978

Serum levels of TSH, T3, rT3, T4 and T3-resin uptake in surgical trauma.

Changes in thyroid hormone metabolism induced by surgical trauma were studied by determination of TSH, T3, rT3, T4 and T3-resin uptake before, during and after mastectomy in 20 women and cholecystectomy in 10 women. Pronounced and reciprocal changes, explained by altered peripheral T4 metabolism were found concerning T3 and rT3. The decreased T3 and increased rT3-levels approached or exceeded the limits of the reference range on the first post-operative day. A significant increase in T3-resin uptake and a decrease in serum T4 were already observed during surgery and probably was caused by a decreased protein binding capacity. An increased concentration of TSH in the serum during surgery was followed by a significant post-operative decrease, possibly due to a suppressive effect of endogenous cortisol. No obvious difference in absolute values or the pattern of change was found between the mastectomy and cholecystectomy groups, although a somewhat more pronounced and retarded alteration in rT3 was found after cholecystectomy.

Adult↗