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Biomedical subjects

P Gullstrand

Publications and source records attributed to P Gullstrand.

36 records · Page 2Linked to original sources
PubMed1983

Increased susceptibility to pneumococci after ligation of the splenic artery in experimental hypersplenism.

22 male Sprague-Dawley rats were divided into two groups, of which group I received methylcellulose and group II saline intraperitoneally for 12 weeks. After ligation of the splenic artery of the animals in group I and sham operation of the rats in group II, the injections were continued for a further 9 weeks. At the operation, the group I animals all showed signs of hypersplenism with anemia, and leuko- and thrombocytopenia. The platelet counts normalized after the operation, a marked leukocytosis developed and the anemia was further aggravated. At the end of the study, the animals were challenged with 4 x 10(6) colony-forming units of pneumococci type 1, resulting in deaths of 11 of 12 animals in group I, in contrast to survival of all 10 rats in group II (p = 0.000017).

Animals↗
PubMed1983

Splenic resection or heterotopic transplantation of splenic tissue as alternatives to splenectomy. Regeneration and protective effect against pneumococcal septicemia.

In 82 male Sprague-Dawley rats, divided into eight groups according to surgical procedure performed (total splenectomy, sham operation and six different modes of splenic conservation), resistance to intravenous injection of 4 X 10(3) CFU of Streptococcus pneumoniae type I was evaluated 16 weeks after the surgical procedures. Significant regeneration of the spleen and almost normal resistance to pneumococci was seen 16 weeks after a two-thirds resection. Pieces of the spleen, implanted subcutaneously or into the greater omentum, also showed marked regeneration; though survival time was prolonged, the mortality among these animals following injection with pneumococci did not, however, differ from that of totally splenectomized animals. Dispersed splenic tissue, injected subcutaneously, intramuscularly, or retroperitoneally, showed less sign of regeneration and had no effect on mortality or survival time in partially vis-à-vis totally splenectomized rats.

Animals↗
PubMed1983

Total serum bile acids, gamma-glutamyl transferase, prealbumin, and tyrosine: sensitive serum markers of hepatic dysfunction in alcoholic liver cirrhosis.

Of 33 components analyzed in overnight fasting serum from 30 patients with alcoholic liver cirrhosis, portal hypertension, and bleeding esophageal varices, total serum bile acids, gamma-glutamyltransferase, prealbumin, and tyrosine were the most frequently abnormal 'liver tests'. Total serum bile acids correlated significantly with bilirubin, immunoglobulin M, threonine, glycine, methionine, and tyrosine. Gamma-glutamyltransferase correlated with aspartate aminotransferase, glutamine, and alanine. Prealbumin correlated with albumin and immunoglobulins G and A. Tyrosine correlated with total bile acids, orosomucoid, and 10 amino acids. The amino acid ratio of valine + isoleucine + leucine to tyrosine + phenylalanine was lowered in all patients. It is concluded that the clinical picture and pattern of serum components in patients with alcoholic liver disease are influenced by many complex pathophysiological mechanisms.

Adult↗
PubMed1983

Pattern of serum beta-hexosaminidase in liver cirrhosis.

The activity of the primarily lysosomal hydrolase, beta-hexosaminidase (EC 3.2.1.30), was studied in serum from 53 patients with bleeding esophageal varices, portal hypertension, and liver cirrhosis (31 alcoholic, 13 cryptogenic, and 9 primary biliary). The serum enzyme activity was determined on 89 occasions and was increased in 93%. There was no difference in the distribution between the three patient groups, but in patients who underwent portal-systemic shunt surgery there was a significant increase after 9-12 months. Serum beta-hexosaminidase activity correlated significantly with other biochemical tests known to be influenced by portal-systemic shunting. It is concluded that determination of this enzyme might become a useful liver test, since it sensitively detects liver disease and also might be specific, since besides liver disease only pregnancy and lysosomal disorders are known to show considerable elevations in serum activity.

Esophageal and Gastric Varices↗
PubMed1982

Evaluation of splenic embolization in patients with portal hypertension and hypersplenism.

Twenty-five patients with hypersplenism caused by portal hypertension were treated by repeated partial splenic embolization. Fourteen surviving patients were followed for up to six years showing a good response on peripheral blood count and bleeding tendency. Three patients died in connection with the treatment and another eight died within half a year because of the underlying liver disease. The discomfort and complications of fever, pain, pleural effusion, and abscess formation and the possibility to avoid these by repeated partial embolization under antibiotic cover are discussed. The results are compared with reports in the reviewed actual literature and the splenic embolization is given a place among the means of a successful selective symptomatic treatment of partial hypertension.

Adult↗
PubMed1982

Immunocompetence after incidental splenectomy.

Of 377 patients with chronic duodenal ulcer undergoing highly selective vagotomy, 13 were splenectomized peroperatively because of capsular tear. 12 of these patients were alive at the time of the subsequent investigation and each was matched with a non-splenectomized patient. The postoperative interval was almost 5 years (median). The splenectomized patients were characterized by their longer hospitalization, and increased blood counts of lymphocytes, monocytes and platelets. Analysis of lymphocyte subsets revealed increased numbers of both T and B lymphocytes after splenectomy Among the T cells, those with receptors for Fc of IgG were significantly more numerous in the splenectomized group. It is a matter of controversy whether or not this population contains T suppressor cells. Hence further functional investigations are needed to clarify whether our observations bear any relation to the low level of plasma IgM found by us and others in splenectomized individuals. Screening for complement activation by the classical and alternative pathways did not reveal any defects resulting from splenectomy.

Adult↗
PubMed1982

Increased susceptibility of hypersplenic rats to infection with pneumococci.

Hypersplenism was induced in rats by intra-peritoneal injections of methylcellulose. These rats developed an outsize spleen and had significantly depressed values for hemoglobin concentration, hematocrit and platelet count. The rats given methylcellulose were also found to be more susceptible to a challenge with a standardized intravenous injection of Streptococcus pneumoniae and had a significantly higher mortality rate than the control rats.

Animals↗
PubMed1982

Emergency and long-term transesophageal sclerotherapy of bleeding esophageal varices. A prospective study of 50 consecutive cases.

Fifty consecutive unselected patients with endoscopically proven bleeding esophageal varices were on 76 occasions during 3 years treated with transesophageal sclerotherapy. One-week hemostasis was obtained in 89%, with a hospital mortality of 14%. Three major complications (1.1%) occurred, with one fatal outcome. Long-term repeated sclerotherapy was instituted according to our protocol in all the survivors. During a mean follow-up period of 26 months 19 patients have been treated with sclerotherapy alone, 10 had elective and 2 had emergency operative procedures because of rebleeding. Six fatal bleedings occurred, four after sclerotherapy alone. The 3-year survival is calculated to be 49%. Sclerotherapy has proven to be effective and safe and can be recommended especially in the acute situation. It can also be used as long-term treatment, but rebleedings will in several cases necessitate operative procedures.

Adult↗
PubMed1982

Effect of steroids on the outcome of penicillin treatment in pneumococcal sepsis in splenectomized rats.

Increased morbidity in septic infections following splenectomy is a well-known phenomenon; despite antibiotic treatment the mortality rate associated with such infections is about 50%. Combined steroid-penicillin treatment of experimental pneumococcal sepsis was investigated in splenectomized Sprague-Dawley rats subjected to intravenous challenge with 200 colony-forming units (CFU) of pneumococci. Dexamethasone alone had no therapeutic effect. Benzylpenicillin alone was effective when given "early," i.e. 18 and 42 hours after challenge (0 of 10 animals killed), but not when given "late," i.e at 24 and 48 hours (10 of 14 killed). By contrast, even with "late" administration the combined treatment with dexamethasone and benzylpenicillin was effective against lethal pneumococcal sepsis (1 of 14 killed).

Animals↗
PubMed1982

Peritoneovenous shunting for intractable ascites.

For 5 years (1976-1981) peritoneovenous shunting has been used in 32 patients with intractable ascites--that is, in patients in whom medical therapy has failed. All operations but one were performed using local anesthesia. The LeVeen shunt was used in 29 patients and the Denver shunt in three patients. Good palliation was achieved in 14 of 23 patients with ascites due to liver cirrhosis. Seven out of eight patients with tense ascites secondary to malignancy were relieved. Complications were seen in six patients. In one patient severe disseminated intravascular coagulopathy made removal of the shunt necessary. Leakage, local infection, and skin necrosis, when present, could successfully be treated without removing the shunt. The surgical procedure is simple and offers relief to most patients with tense ascites resistant to medical therapy.

Adolescent↗
PubMed1981

Improvement of the splenectomized rat model for overwhelming pneumococcal infection. Standardization of the bacterial inocula.

Studies conducted on rats have shown an increased susceptibility after splenectomy to intravenously introduced pneumococci. One of the main obstacles in such experiments, as regards reproducibility, is the maintenance and handling of the bacteria. A procedure is described for the preparation of standardized inocula and preservation of the bacteria at -80 degree C. No change in viability or virulence was observed after storage for at least 6 months. A pronounced difference in susceptibility to type 1 pneumococci was found between sham-operated (LD100 greater than 2 X 10(4) colony-forming units) and splenectomized rats (LD100 less than 2 X 10(2) colony-forming units); in the latter group, the survival time was inversely correlated to the quantity of bacteria injected.

Animals↗
PubMed1981

Regional, portal hypertension in chronic pancreatitis.

Because of a close anatomical relationship to the splenic vein chronic pancreatitis can cause obstruction to the splenic outflow. Regional portal hypertension develops and collateral flow sometimes gives rise to gastric and oesophageal varices which can cause life-threatening bleeding. Three cases with regional portal hypertension secondary to chronic pancreatitis are presented. Two of them were treated with surgical splenectomy and the third had an embolization of the splenic artery. Regional portal hypertension should be suspected in a patient with a history of chronic pancreatitis who is bleeding from gastric of oesophageal varices. The treatment of choice is surgical splenectomy. In high risk patients embolization of the splenic artery can be tried.

Adult↗
PubMed1977

Clinical evaluation of bone-densitometry in patients with final renal insufficiency operated for hyperparathyroidism.

Because of difficulties in evaluating bone mineral mass with conventional methods in patients with final renal insufficiency before and after parathyroidectomy, bone densitometry has been tried. During a three year period ten patients have been selected for surgery. The parathyroidectomy performed was total in nine patients and subtotal in one. Bone mineral mass was significantly lower preoperatively in the operated patients than in other patients on regular hemodialysis and also lower than in a normal material. In four of ten patients there was a transient decrease in bone mineral mass after parathyroidectomy. Thereafter there was a significant increase in five of ten patients and in the whole group of patients. Thus bone densitometry was found to be of value in following patients with renal insufficiency selected for parathyroidectomy.

Adult↗
PubMedDate not supplied

Prophylactic effect of human immunoglobulin against pneumococcal post-splenectomy sepsis in the rat.

Failure to clear the blood of pneumococci after splenectomy may be corrected by active immunization, but some patients show poor antibody response to pneumococcal vaccination. Long-term antibiotic prophylaxis against post-splenectomy sepsis carries the risk of development of bacterial resistance and low patient compliance. In the present study, using a rat model for post-splenectomy sepsis, human immunoglobulin was given 24 h before challenging the animals with 10(3) Streptococcus pneumoniae. Immunoglobulin at a dosage of 300 mg/kg body weight was protective. Reducing the immunoglobulin dose to 75 mg/kg did not alter the mortality rate but significantly prolonged the survival time. The results indicate that the new immunoglobulin preparations for intravenous use might provide an effective means of reducing the risk of post-splenectomy sepsis, even in the most susceptible patients.

Animals↗
PubMedDate not supplied

Treatment of hypersplenism An experimental study in the rat.

Methylcellulose injected intraperitoneally into rats proved to give a splenomegaly combined with anemia and thrombocytopenia. The white blood cell count did not change during the treatment. The splenic parenchyma of the hypersplenic rats was then reduced by resection or splenic artery ligation to a different extent. The peripheral blood cell count was normalized after a one-third resection, whereas a more-than-two-thirds reduction of the splenic parenchyma caused infective complications in many rats. It was thus possible to treat the 'secondary hypersplenism' in the rat by a partial reduction of the splenic parenchyma and to avoid total splenectomy, much undesired with new immunologic knowledge.

Animals↗