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Biomedical subjects

N Gabrielsson

Publications and source records attributed to N Gabrielsson.

At least 19 recordsLinked to original sources
PubMed1997

Intravenous cholangiography before 1000 consecutive laparoscopic cholecystectomies.

BACKGROUND: The advent of laparoscopic cholecystectomy has resulted in an increase in common bile duct (CBD) injuries. Routine intraoperative cholangiography has been advocated to prevent these injuries. This study describes an alternative management strategy applied to a consecutive series of 1000 patients having laparoscopic cholecystectomy. METHODS: In patients with no history of contrast allergy and no suspicion of CBD stones, preoperative intravenous cholangiography (i.v.c.) was performed routinely. Patients with suspected or detected CBD stones were referred for endoscopic retrograde cholangiography. This strategy was supplemented by selective intraoperative cholangiography. RESULTS: Overall 782 of the 1000 patients had successful preoperative i.v.c., allowing detection of 30 CBD stones and providing useful information about anatomical variation in CBD anatomy. Patients with inconclusive i.v.c. studies, or those with a history of contrast allergy, had intraoperative cholangiography, which demonstrated a further 19 CBD stones. There were no contrast reactions and no damage to the biliary system which might have been obviated by intraoperative cholangiography. In the 724 patients who did not require complimentary intraoperative cholangiography, there has been no clinical evidence of missed CBD stones. CONCLUSION: Routine preoperative i.v.c., with reservation of intraoperative cholangiography for indeterminate i.v.c. examinations or the need for anatomical clarification, is a safe strategy for laparoscopic cholecystectomy.

Cholangiography↗
PubMed1993

Patients with persistent elevation of aminotransferases: investigation with ultrasonography, radionuclide imaging and liver biopsy.

Eighty-three patients, submitted for investigation of the liver due to persistently elevated activities of serum aminotransferases were included in a study in order to compare the relative merits of liver biopsy, ultrasound and radionuclide imaging. From the liver biopsy it was found that 45 patients had fatty liver, 14 had cirrhosis and 11 had chronic inflammation, 3 had haemochromatosis and 10 had unspecific changes or normal findings. An investigation with ultrasound yielded pathological findings in 65% of the patients. The sensitivity was highest in patients with fatty liver (82%) and more than 10% fat in the liver always resulted in increased echogenicity. Alterations in the liver due to cirrhosis and chronic inflammation were detected with ultrasound in only 50% and 57% of the cases, respectively. Radionuclide imaging was positive in 44% of the patients with fatty liver. 64% of those with cirrhosis and 21% of the patients with chronic inflammation. It was only possible to distinguish fatty liver from cirrhosis in those patients who had an increase in the size of the spleen (four patients). The study demonstrates that in patients with a persistent elevation of serum aminotransferases ultrasound has a high sensitivity for detecting more than 10% fat in the liver. However, both the ultrasound and a liver scintigram had a rather low sensitivity and a very low specificity for making a diagnosis for this group of patients. With the aid of a liver biopsy it was possible to establish a diagnosis in 90% of the patients.

Adult↗
PubMed1991

Mixed colorectal polyps. An immunohistologic and mucin-histochemical study.

The morphology of mixed colorectal polyps was analysed. Thirteen such polyps were found out of 2700 colorectal polyps (0.5%). Histology showed a spectrum of hyperplastic crypts from almost pure goblet cell population (two polyps) to hypermature serrated epithelium with scanty goblet cells (seven polyps). Tubular adenomas occurred in 12 polyps, and a tubulovillous adenoma was found in the largest polyp. Moderate dysplasia was seen in the five large polyps. The border between neoplastic and hyperplastic cells was usually sharp. Mucin histochemistry showed similarities between the mixed polyps and colorectal carcinomas--namely, the reduction/absence of sialomucin in both mature hyperplastic crypts and adenomatous glands. The expression of carcinoembryonic antigen within the hyperplastic crypts and within the neoplastic crypts showing moderate dysplasia was similar to that seen in colorectal carcinomas, whereas it was normal within the neoplastic crypts with low-grade dysplasia. IgA was reduced or absent in both components. Blood group antigen was found only within the adenomatous component of the largest polyp showing also moderate dysplasia.

Adenoma↗
PubMed1989

Unsatisfactory effect of cyclosporin A treatment in Crohn's disease: a report of five cases.

Five patients with chronic continuous Crohn's colitis were treated with peroral Cyclosporin A (CyA) for 3 months in an open, uncontrolled pilot trial. The CyA dose was 10 mg kg-1 d-1 the first month of study, and thereafter 5 mg kg-1 d-1. Three of the patients initially showed some response to the treatment with decreases in the Crohn's disease activity index, but subsequently deteriorated. In one patient the condition was unchanged and another clearly worsened. Increases in serum creatinine levels were noted in three patients, and all of these also had decreased 51Cr-EDTA clearance indicating impaired renal function. Hypertrichosis and hyperaesthesia were also noted as side-effects. This study does not support the use of CyA in the short-term treatment of Crohn's disease in the colon.

Adult↗
PubMed1988

Sclerosing cholangitis in cystic fibrosis.

Four of 102 patients with cystic fibrosis with symptoms or signs suggesting sclerosing cholangitis had typical findings at endoscopic retrograde cholangiography (ERC), indicating this syndrome. All patients had pulmonary symptoms, pancreatic insufficiency, and pathologic sweat test results. Three females (aged 15-20 years), two of whom had unspecific colitis, presented with abdominal pain, and a 25-year-old male patient was asymptomatic. Two of the patients had persistently and one patient only intermittently pathologic serum concentrations of transaminases and gamma-glutamyltransferase. The fourth patient, who only had a transient increase of standard liver function tests, showed no progress in any variable (including liver biopsy and ERC) for 3 years, indicating a benign course. Disturbances of the liver and biliary system are well-known complications in cystic fibrosis. Our observations indicate that sclerosing cholangitis is another expression of biliary tract involvement in this disease.

Adult↗
PubMed1986

Endoscopic papillotomy in the management of choledocholithiasis.

Endoscopic papillotomy was attempted in 72 patients with common bile duct stones, 47 of whom previously had been cholecystectomized and 25 with their gallbladder still present. Papillotomy was successful in 69 patients (96%) and the duct was cleared of stones in 63 (88%). Nine patients thus needed elective surgery. There was no mortality following papillotomy and no grave complication occurred. On the follow-up, from 5 months to 10 years (mean 4 years), only one of the 63 patients with successful papillotomy has required operation. Endoscopic papillotomy is effective for treating many patients with choledocholithiasis, both in those following cholecystectomy and in those with gallbladders in situ.

Adult↗
PubMed1986

Nonresectable malignant bile duct obstruction. Surgical bypass or endoprosthesis?

Forty-one patients with malignant obstructive jaundice, not amenable to radical surgery, had biliary decompression by either surgical bypass or endoscopically introduced endoprosthesis. The two treatment groups were statistically comparable with reservation for age, which was significantly lower in the operated group. Judged by the effect on bilirubin and alkaline phosphatase levels the two methods were equally efficient. Major complications were more common and initial hospital stay was significantly longer in the surgical bypass group. Neither early mortality nor survival differed between the groups. Implications of these data in the management of patients with unresectable malignancy are discussed.

Aged↗
PubMed1985

Guaiac tests for detection of occult faecal blood loss in patients with endoscopically verified colonic polyps.

To evaluate the sensitivity of guaiac tests for colonic polyps, two tests were made on occult blood in faeces--Hemoccult II and Fecatwin-S--from 625 and 549 patients, respectively, referred for colonoscopy. Polyps were found in 212 and 194 patients, and these had one or more tests positive in 41% (Hemoccult II) and 48% (Fecatwin-S). The incidence of positive tests was greater for polyps situated in the transverse, descending, and sigmoid colon; for polyps with a stalk, villous elements, and dysplasia; and especially for large polyps. Although size was the most important factor for the bleeding tendency, at least one third of patients with polyps over 10 mm in diameter had no positive guaiac reactions. In patients at high risk of developing polyps, therefore, these tests cannot replace, but may well be supplementary to, radiography with double-contrast technique and colonoscopy.

Adolescent↗
PubMed1980

Precancerous lesions in the mucosa in ulcerative colitis. A radiographic, endoscopic, and histopathologic study.

A series of 150 patients with ulcerative colitis, 100 of which had had the disease more than 10 years, underwent colonoscopy on at least one occasion. 4700 biopsies of the mucosa of the gut were taken and examined histopathologically. 148 of the colonoscopies were performed within 12 months of the radiographic examination of the colon. Precancerous lesions were detected in 12 patients and moderate to severe reactive inflammatory changes in 39. One of the 12 patients with precancerous lesions was found to have a carcinoma in the same region at surgery 18 months later. No further cases of carcinoma in the series have been observed at follow-up surgery. Radiography and endoscopy demonstrated a higher rate of certain features of inflammation in the parts of colon with precancerous lesions, but no particular feature could be taken to indicate the presence of such lesions. All patients with precancerous lesions had on some occasion been radiologically and/or endoscopically judged to have total colitis, compared with 75% in the whole series. Analysis of clinical data in patients with and without precancerous lesions revealed no significant difference between the groups.

Adult↗
PubMed1979

Extent of inflammatory lesions in ulcerative colitis assessed by radiology, colonoscopy, and endoscopic biopsies.

Radiography of the colon with double-contrast technique was performed directly after total colonoscopy with multiple biopsies in 50 patients with ulcerative colitis. In two-thirds of the series the inflammatory lesions were found to be more widespread at colonoscopy than on radiography. Signs of colitis in an even larger part of the bowel were found on examination of the biopsies in half of the cases. The distribution of characteristic inflammatory changes seen at colonoscopy was also studied. The frequency of the lesions was found to be relatively low in the rectum and highest in the descending and sigmoid parts of the colon.

Adult↗
PubMed1979

Diminutive colonic polyps--clinical significance and management.

Of 300 diminutive polyps (up to 5 mm) found at colonoscopy, 114 were neoplastic (37 per cent) and thus possible precursors of carcinoma. This suggests that all colonic polyps, regardless of size, should if possible be extirpated or coagulated. As polyps of this small size often escape detection roentgenologically, especially by conventional technique, colonoscopy should be extended to involve the entire colon. This is because diminutive polyps, especially of neoplastic type, are common also in the proximal part of the colon.

Adult↗
PubMed1978

Malignancy of colonic polyps. Diagnosis and management.

The risk of malignant degeneration of colonic polyps has traditionally rested on various roentgenographic criteria such as broad base, irregular surface and size larger than 1 cm. With the aim of facilitating the choice of treatment of colonic polyps, an appraisal is made of the morphology of 200 polyps removed from 154 patients. The results of barium enema and double contrast techniques are compared with those obtained at colonoscopy. Radiography is found to have considerable shortcomings in evaluation of the appearance of the polyp. As the correlation of the gross morphology of the polyp of histology is weak endoscopic polypectomy should be performed whenever possible.

Colon↗