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Biomedical subjects

P Gullstrand

Publications and source records attributed to P Gullstrand.

At least 19 recordsLinked to original sources
PubMed1998

Standardized CT examination of the multitraumatized patient.

The aim of this study was to develop a standardized non-helical-CT protocol including head, body and proximal extremities in order to achieve a good time efficiency and diagnostic accuracy in the initial radiological evaluation of the multitraumatized patient. A total of 111 circulatory stable blunt trauma patients, brought in to a trauma level II-III hospital, were examined according to a standardized CT protocol. After examining the head with contiguous 10-mm slices without i.v. contrast medium injection, the trunk was examined with 10-mm slices every 30 mm through thorax-abdomen-pelvis with i.v. contrast medium enhancement (occasionally modified). All data in the medical reports were collected and used as "end-point", and the outcome of the CT examination was compared with this final diagnosis. Mean examination time was 20 min (range 12-32 min). In total, 55 head injuries, 89 thoracic injuries, 27 abdominal/pelvic injuries and 62 fractures were found. Computed tomography correctly identified the injuries, except one brain stem injury, one contusion/rupture of the heart, one hepatic injury, two intestinal injuries, eight vertebral injuries and one joint dislocation. A standardized non-helical-CT examination of the head and body may be achieved in 20 min. Its diagnostic accuracy was high, except for vertebral column injuries, which is why we recommend it as the method of choice for initial radiological examination of multitraumatized patients. When available, helical scanning would improve both examination speed and accuracy.

Abdominal Injuries↗
PubMed1987

Serum proteins in liver cirrhosis: effects of shunt surgery.

The serum protein patterns of 38 patients with alcoholic liver cirrhosis were studied and compared with those of 15 patients with cryptogenic cirrhosis and of 18 normal volunteers. Serum prealbumin and albumin were significantly lowered in alcoholic liver cirrhosis in comparison with the normals. In liver cirrhosis, the four acute phase reactants, alpha 1-antiproteinase, orosomucoid, and haptoglobin and caeruloplasmin, showed a pattern in serum, in which alpha 1-antiproteinase was increased, orosomucoid and haptoglobin were decreased, and caeruloplasmin was normal. Immunoglobulins G, A and M were significantly elevated. IgA was significantly more elevated in patients with alcoholic disease than in patients with cryptogenic cirrhosis. The construction of a surgical portal-systemic shunt resulted in a significant decrease in serum concentrations of the acute phase reactants, while prealbumin, albumin and immunoglobulins were unaffected.

Acute-Phase Proteins↗
PubMed1986

Hypersplenism--effect on haemostasis. An experimental study in the rat.

Hypersplenism induced by methylcellulose given to rats i.p. was characterized by splenomegaly, anaemia, leucocytopenia and thrombocytopenia. Hb, Hct and WBC count were normalized, and platelet count rose to supernormal values by splenectomy. At a standardized liver resection, the hypersplenic rats had an increased blood loss and prolonged bleeding time in comparison with control rats. Removal of the large spleen normalized these abnormalities. Hypersplenism also shortened APT time and impaired ADP and collagen-induced platelet aggregation, findings not normalized by splenectomy.

Animals↗
PubMed1986

Treatment of pneumococcal postsplenectomy sepsis in the rat with human gamma-globulin.

A rat model was used to evaluate the possible effect on experimental postsplenectomy sepsis of a human gamma-globulin preparation for intravenous use (Sandoglobulin). Sixty splenectomized male Sprague-Dawley rats were given 3 X 10(3) Streptococcus pneumoniae type 1 intravenously. Twelve of the animals received no treatment and all died, in contrast to 12 sham-operated controls which all survived the challenge. The remaining splenectomized rats were divided into four groups, each consisting of 12 animals. One group was given 120 mg human gamma-globulin twice intraperitoneally (0.3 g/kg body wt), at 18 and 42 hr, after challenge; 10 of the 12 survived, in contrast to none of the 12 in the second group receiving 120 mg human albumin instead of gamma-globulin (P = 0.00003). When the injections were delayed to 24 and 48 hr, 9/12 gamma-globulin-treated animals still survived, in contrast to 0/12 in the albumin group. These findings point to new possibilities for treatment and perhaps prevention of overwhelming postsplenectomy sepsis by administration of high doses of gamma-globulins.

Albumins↗
PubMed1986

Synergism between gammaglobulin prophylaxis and penicillin treatment in experimental post-splenectomy sepsis in the rat.

In spite of long-term antibiotic prophylaxis and pneumococcal vaccination, there still exists a proportion of highly susceptible splenectomized or functionally hyposplenic patients at risk of contracting fatal overwhelming infections. We have studied the effect of gammaglobulin prophylaxis in experimental sepsis among splenectomized rats. Administration of 37.5 mg human gammaglobulin/kg body weight 24 h before challenge with 10(3) pneumococci resulted in the survival of 19 of 24 rats, in contrast to 1 of 24 controls. A dose of 19 mg/kg body weight was not protective (7 of 23 survived). However, treatment with penicillin 18 h after challenge in the gammaglobulin-pretreated group of animals saved 21 of 24 animals, although penicillin without gammaglobulin prophylaxis showed no effect. These data indicate that even relatively low circulating concentrations of specific antibody after gammaglobulin prophylaxis might nonetheless be adequate to render septic disease easier to treat.

Animals↗
PubMed1986

Comparison of antibody levels and protective efficacy against pneumococci in two immunoglobulin preparations for intravenous use.

Passive immunization with modern intravenous immunoglobulin preparations might be used prophylactically in individuals at extreme risk of contracting postsplenectomy sepsis or therapeutically in established infections. Since pneumococci are the predominant causative organisms, we determined antibodies against 14 pneumococcal serotypes in two commercially available immunoglobulin preparations (two batches of each) using enzyme-linked immunosorbent assay. The four batches were remarkably similar in antibody content. Low levels against some clinically important serotypes, i.e. types 3, 8 and 18C were recorded. The protective effect of one batch of each preparation against type 1 pneumococci was documented in splenectomized rats.

Animals↗
PubMed1986

Effect of gamma globulin infusion on type-specific pneumococcal antibody levels in splenectomized adults.

Using an ELISA technique, changes in specific antibody levels against pneumococcal serotypes 1, 4, 7F, 14, 18C and 23F were studied in 8 adults healthy at the time of investigation but splenectomized previously because of hematological disease following infusion of 200 mg/kg body weight of a commercially available immunoglobulin preparation for intravenous use (Sandoglobulin). Among the 4 patients with initially low serum levels of antipneumococcal antibodies, significantly raised antibody levels were demonstrated against type 14 for 8 weeks. On the other hand, the infusion did not lead to increased antibody levels in 3 patients with high preinfusion values for antipneumococcal antibodies. In contrast, a significantly lower antibody value for type 7F was recorded 3 weeks after infusion. Efficacy of immunoglobulin prophylaxis is, therefore, probably doubtful in certain splenectomized patients, and if contemplated should be preceded by analysis of antibody levels against common pathogens.

Adolescent↗
PubMed1986

Portal-systemic encephalopathy. Influence of shunt surgery and relations to serum amino acids.

Fifty patients with liver cirrhosis, portal hypertension, and a history of bleeding oesophageal varices underwent 15 different cognitive psychometric tests to evaluate the presence of subclinical portal-systemic encephalopathy. None of the patients were clinically encephalopathic. The patients were compared with 50 healthy control subjects. Twenty-three patients showed definite signs of encephalopathy in the psychometric tests, 17 were normal, and 10 were borderline cases. The most pronounced abnormalities were seen in tests reflecting logic inductive capacity, visual spatial performance, cognitive flexibility, perceptual speed, spatial perceptive ability, and psychomotor performance. Tests reflecting word memory were less affected. Serum liver function tests did not differ between patients with deranged and normal brain functions. The serum isoleucine concentration was, however, significantly lower in the encephalopathic patients. The psychometric test results did not differ between patients with alcoholic and nonalcoholic liver cirrhosis, and no change was noted 2 years after shunt surgery.

Amino Acids↗
PubMed1986

Nonoperative treatment of blunt trauma to liver and spleen.

Nonoperative management of 20 cases of liver injury in 1969-1984 and 13 of splenic injury in 1977-1984, all due to blunt abdominal trauma, is retrospectively reviewed. The total of blunt hepatic injuries treated in the same period was 63 and that of blunt splenic injuries 52. There were no major differences in etiology, age, sex distribution or need for blood transfusion between the liver and splenic trauma cases. After initial resuscitation and diagnostic work-up with angiography, computed tomography, ultrasonography and/or scintiscan, circulatorily stable patients were selected for nonoperative treatment. These patients showed evidence of mild trauma with few associated major injuries, few complications and no mortality. Following initial bedrest and observation, they were gradually mobilized and could leave the hospital after about 2 weeks.

Adolescent↗
PubMed1985

Preoperative herniography in clinically manifest groin hernias.

Herniography was performed in 88 patients (7 females, 81 males) clinically judged to have a groin hernia. The preoperative herniography demonstrated the exact type of hernia in 62 out of 94 hernias operated on (66%), and the hernias found at operation were predicted by the herniography in 69 out of 94 hernias operated on (73%). A contralateral asymptomatic hernia was revealed by herniography in 17 out of 88 patients. The majority (11) of these hernias were small and lateral. One patient with an asymptomatic femoral hernia underwent hernioplasty. The remaining 16 patients have not been operated on and have remained symptom-free. According to our experience, preoperative herniography does not appreciably alter the operative management of patients with clinically manifest groin hernias. Although the examination reveals a significant number of additional asymptomatic hernias, this diagnostic knowledge is probably of minimal clinical significance, especially when considering the discomforts and cost of the examination.

Adult↗
PubMed1984

Total fasting serum bile acids and beta-hexosaminidase in alcoholic liver disease.

Total serum bile acid levels and beta-hexosaminidase activity were studied in 22 normal subjects, 35 non-cirrhotic patients with acute alcohol intoxication, 45 patients with alcoholic liver cirrhosis and 11 patients with alcoholic liver cirrhosis and surgical portal-systemic shunts. Comparison was made with traditional liver function tests. beta-Hexosaminidase was most frequently elevated in acute alcohol intoxication (94%) while total serum bile acids were elevated in all patients with alcoholic liver cirrhosis. Total serum bile acid levels were found to discriminate most efficiently between acute alcohol intoxication and liver cirrhosis. The combined determination of serum beta-hexosaminidase and total serum bile acids is proposed for evaluating alcoholic liver disease.

Alcoholic Intoxication↗
PubMed1984

Administration route and splenectomy effects on resistance to pneumococci in rats.

Normal and splenectomized rats were challenged with Streptococcus pneumoniae type 1 via different administration routes. In experiment I, previously splenectomized or sham-operated rats received 4 X 10(3) colony-forming units (CFU) of pneumococci via (i) a peripheral vein, (ii) subcutaneously, or (iii) intraperitoneally. The results indicated an increased susceptibility of the splenectomized animal to pneumococci administered via all three routes. However, subcutaneously administered pneumococci gave a lower mortality than pneumococci given intravenously or intraperitoneally. In experiment II 40 splenectomized rats received 4 X 10(3) CFU of pneumococci via (i) peripheral, (ii) portal, or (iii) caval veins or the aorta. No differences in mortality were found. In experiment III, non-operated animals received 4 X 10(5) CFU of pneumococci either intravenously or intraperitoneally, resulting in mortality rates of 0/20 and 17/20, respectively. After 2 weeks the rats surviving intravenous challenge received 4 X 10(5) CFU of pneumococci intraperitoneally; all survived. The data indicate the the spleen and the subcutis have a greater capacity to protect against pneumococci in the absence of specific antibody than the peritoneum or the circulation outside the spleen.

Animals↗
PubMed1984

Herniography--a useful diagnostic method in patients with obscure groin pain.

118 adult patients (45 females, 73 males) with obscure inguinal pain but without clinical signs of hernia were investigated with herniography. The examination revealed inguinal hernia in 37 instances (15 females, 22 males; 31.3%). Thirty out of these 37 patients (12 females, 18 males) have been operated on. Two false positive cases of the herniography examination have been encountered, giving a diagnostic specificity of herniography of 93.3% (95% confidence interval 78-99%). Six patients (5 females, 1 male) with a negative result of herniography have been operated on. One hernia was detected among these, i.e. one false negative result of herniography. The remaining 75 patients (25 females, 50 males) with a negative result of herniography have not yet developed any hernia. We conclude that herniography is a valuable radiological investigation for demonstration of adult preclinical hernia.

Adolescent↗
PubMed1984

Pattern of serum amino acids in patients with liver cirrhosis. Influence of shunt surgery and transesophageal sclerotherapy.

The serum amino acid pattern was studied in 30 patients with alcoholic liver cirrhosis, in 15 patients with non-alcoholic cirrhosis, and in nine healthy controls. Patients with alcoholic liver cirrhosis had significantly increased serum levels of aspartic acid, proline, methionine, tyrosine, phenylalanine, and tryptophan compared with controls. Valine was significantly decreased. Patients with non-alcoholic liver cirrhosis differed from patients with alcoholic liver cirrhosis only in having significantly greater serum levels of glycine. The serum amino acid pattern of nine cirrhotic patients who underwent mesocaval interposition shunt surgery because of bleeding esophageal varices was prospectively compared with that of nine matched patients treated with transesophageal sclerotherapy. A further significant increase in methionine and tyrosine serum levels was noted after shunt surgery. It is concluded that sclerotherapy influences serum amino acids less, which might be an advantage in relation to the development of hepatic encephalopathy.

Adult↗
PubMed1983

Pharmacologic influence on esophageal varices: a preliminary report.

Selective catheterization of the left gastric vein was performed after percutaneous transhepatic portography (PTP) in patients with portal hypertension and esophageal varices. Following the hypothesis that drugs increasing the lower esophageal sphincter (LES) pressure may obstruct the variceal blood flow through the lower esophagus, the effect of different drugs (i.e., intravenous injection of vasopressin, pentagastrin, domperidone and somatostatin and subcutaneous injection of metacholine) on the variceal blood flow was examined. Vasopressin did not change the variceal blood flow; pentagastrin, with its known effect of increasing the LES pressure produced a total interruption of the flow in four of eight patients; domperidone, also known to increase the LES pressure obstructed the variceal blood flow in the only patient examined with this drug; somatostatin has no reported action on the LES but blocked the flow in one of two patients; and metacholine, reported to increase the LES pressure did not produce any change in the flow in the three patients examined. LES pressure was recorded before and during vasopressin infusion in seven patients with portal hypertension and esophageal varices. No reaction on the pressure was found. The patient number in the study is small and the results are nonuniform but still they suggest that drugs increasing the LES tonus might be useful to control variceal blood flow.

Adult↗