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Biomedical subjects

P Rolny

Publications and source records attributed to P Rolny.

At least 37 records · Page 2Linked to original sources
PubMed1991

Effect of cholecystectomy on the relationship between hydrostatic common bile duct pressure and sphincter of Oddi motility.

The sphincter of Oddi (SO) motility before and after an artificial elevation of the common bile duct pressure was studied by means of endoscopic manometry in nine female subjects, seven of whom had undergone previous cholecystectomy. An increase in the hydrostatic common bile duct pressure resulted in total inhibition of the phasic SO contractions in the two patients with gallbladders in situ, as well as in four of the cholecystectomized patients. The results thus indicate that the inhibitory effect of hydrostatic common bile duct pressure on the SO motility previously demonstrated in the cat is also present in man. On the other hand, as the inhibition of the phasic contractions failed to occur in three of the postcholecystectomy patients, the findings also suggest that cholecystectomy may result in altered regulation of SO motility in some patients. This mechanism could then contribute to development of pain in susceptible subjects postcholecystectomy. Finally, the results also showed that pain experienced by some patients upon contrast injection during ERCP bears no relationship to SO motility, but is due to an interindividually variable sensitivity of the bile duct wall to the intraluminal pressure variation.

Abdominal Pain↗
PubMed1991

Endoscopic treatment of anastomotic strictures in Crohn's disease.

The results of endoscopic balloon dilatation in 27 patients with anastomotic strictures caused by Crohn's disease are reported. All patients had obstructive symptoms not responding to corticosteroids and of such a degree that resection or strictureplasty was considered necessary. The patients were followed up for 7 to 38 months after their first dilatation. Eighteen patients were more or less free from obstructive symptoms while the results were less favourable in the remaining nine patients. The median time after the latest surgical intervention was seven years in the group with a successful outcome and 1.6 years in the group with a poor outcome, which may indicate that some patients have a more aggressive form of Crohn's disease where balloon dilatation is only of moderate value. However, all patients experienced at least a temporary effect, so that balloon dilatation can be considered for use in situations where it is desirable to postpone surgery.

Adult↗
PubMed1991

Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.

All patients greater than or equal to 16 years old with a diagnosis of ulcerative colitis were identified in five well-defined catchment areas, representing 12.7% of the Swedish population. Exactly 1500 patients were retrieved, giving a point prevalence of 170/10(5) inhabitants. It was possible to obtain liver function test results less than 2 years old in 94% of the patients and to obtain endoscopic retrograde cholangiographic results in 65 of the 72 patients with abnormal serum alkaline phosphatase values. Primary sclerosing cholangitis was diagnosed in 55 of the patients (3.7%). The prevalence of the disease was 5.5% in patients with substantial colitis and 0.5% in patients with distal colitis. There was a marked male predominance in cholangitis patients compared with colitis patients without cholangitis. Ninety-five percent of the patients with cholangitis had substantial colitis, which was more than the 62% of patients without cholangitis who had colitis. Female patients with cholangitis were older than male patients at the time of diagnosis of both cholangitis and colitis, which contrasted to the equal age at diagnosis of colitis in male and female patients without cholangitis.

Adolescent↗
PubMed1990

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Acute Disease↗
PubMed1989

Clinical significance of manometric assessment of both pancreatic duct and bile duct sphincter in the same patient.

In this study both pancreatic and bile duct sphincter pressures were measured on the same occasion by means of endoscopic manometry in 42 patients with long-standing upper abdominal pain. Nine (53%) of the 17 patients with abnormal sphincter function had a marked difference between the pancreatic duct sphincter pressure (PSOP) and the bile duct sphincter pressure (BSOP): 6 patients with a clinical diagnosis of biliary dyskinesia showed elevated BSOPs, whereas the PSOPs were normal. The reverse, an abnormal PSOP but normal or only a slightly elevated BSOP, was registered in the three patients with chronic pancreatitis. These findings indicate that a motor abnormality may be restricted to only one of the sphincters. Thus, when the sphincter of Oddi is investigated only from the pancreatic duct, manometry may either fail to show an abnormal BSOP in some patients with biliary dyskinesia, or it may falsely suggest this diagnosis in patients with unrecognized pancreatitis.

Adult↗
PubMed1986

Paradoxical response of sphincter of Oddi to intravenous injection of cholecystokinin or ceruletide. Manometric findings and results of treatment in biliary dyskinesia.

Sixty two patients with a clinical suspicion of biliary dyskinesia were investigated with endoscopic manometry of the sphincter of Oddi before and after intravenous injection of cholecystokinin or ceruletide. In 52 patients injection was followed by decreased pressure in the sphincter of Oddi; 43 of these had normal prestimulatory values (group I), while the values were raised in the other nine patients (group II). A paradoxical response to intravenous injection was observed in 10 women (group III): increased baseline sphincteric pressure occurred in eight and increase in the amplitude of phasic contractions in four patients. The prestimulatory sphincteric pressure was raised in five and normal in the remaining patients. Eight patients were treated with papillotomy (seven) or balloon dilatation of the sphincter (one). They experienced relief of pain during a follow up period of 11-16 months. Intravenous injection of cholecystokinin or ceruletide may disclose a special type of biliary dyskinesia even in patients with normal prestimulatory manometric findings. Hormone injection increases the diagnostic yield of endoscopic manometry in patients suspected of biliary dyskinesia.

Adult↗
PubMed1986

Endoscopic manometry of the sphincter of Oddi and pancreatic duct in chronic pancreatitis.

Pancreatic duct pressure was studied by endoscopic manometry in 12 patients with chronic pancreatitis and in 9 patients with a normal pancreas (suspected biliary dyskinesia). To study the effect of increased intraduodenal concentration of pancreatic enzymes, the duct pressure was measured before and after intraduodenal enzyme infusion. The mean pancreatic duct pressure was 12 (range, 6-25) mm Hg and 18 (range, 6-38) mm Hg in the pancreatitis and 'control' groups, respectively. The occasional patient in each group who had a high duct pressure also had an elevated sphincter of Oddi pressure. A significant correlation between the two pressures was found in both groups of patients. During intraduodenal infusion of pancreatic enzymes a decrease of the pancreatic duct pressure occurred in only two patients. We conclude that an increased pancreatic duct pressure is not a frequent finding in chronic pancreatitis. An elevation of the duct pressure can also be found in patients without pancreatitis. The sphincter of Oddi pressure appears to be more important for the pancreatic duct pressure than the severity of the pancreatitis. Intraduodenal infusion of enzymes, as done in our study, had an inconsistent effect on the pancreatic duct pressure.

Adult↗
PubMed1985

Intensive intravenous treatment of ulcerative colitis.

Two hundred four courses of intensive intravenous treatment were given to 158 patients with ulcerative colitis. The remission rates in the severe, moderate, or mild attacks were 55.7%, 86.9%, and 91.8%. Total colitis had a great impact on the results, especially in severe attacks. Of these patients, 52.8% were operated on within 3 wk. The relapse rate was exponential, and during the first year 48.1% of the patients in remission relapsed. The extent of the colitis, severity of the attack, or duration of intensive intravenous treatment had no influence on the time of relapse. Twelve patients with chronic continuous disease were given intensive intravenous treatment. No long-term benefit was seen in patients with total ulcerative colitis, but half of those with less extensive colitis showed a good to excellent response to treatment.

Adult↗
PubMed1984

HBsAg-negative chronic active hepatitis and mixed connective tissue disease syndrome. An unusual association observed in two patients.

Two patients are described who suffered from both HBsAg-negative chronic active hepatitis and mixed connective tissue disease syndrome. The diagnosis of liver disease was made prior to the diagnosis of collagenosis in one of the patients, whereas the opposite was the case in the other. In spite of the fact that symptoms and laboratory data suggesting both diagnoses were present from the moment of presentation, there was a considerable delay in establishing the second diagnosis in both patients. To our knowledge, this is the first report on an association between chronic active hepatitis and mixed connective tissue disease syndrome. It illustrates the difficulties when diagnosing overlap conditions.

Adult↗
PubMed1983

Occurrence of Clostridium difficile toxin in inflammatory bowel disease.

The occurrence of Clostridium difficile toxin in faeces has been studied in 53 inpatients with inflammatory bowel disease (IBD) at 57 admissions. Before faecal sampling of the patients had had sulphasalazine therapy--17 for more than 1 year--and 16 patients had taken antibiotics on 20 occasions within the last year. The toxin was found in 3 out of 57 samples (5%). In all cases it could be detected only in undiluted stool filtrate. None of the patients was treated for the C. difficile infection; remission was achieved in two of the patients, whereas the third patient with severe ulcerative colitis was referred to colectomy. Our results suggest that neither IBD as such nor long-term sulphasalazine therapy predisposes to occurrence of C. difficile toxin. Antibiotic therapy in these patients does not imply a higher risk of toxin occurrence than in other patients. In our region there is no need for routine screening for this in symptomatic patients with IBD.

Adolescent↗
PubMed1981

Human pancreatic polypeptide (HPP) immunoreactivity in an infiltrating endocrine tumour of the papilla of Vater with unusual morphology.

Histological, histochemical and clinical features of an endocrine duodenal tumour situated in the papillary region were studied. The tumour had a remarkable mixed histological growth pattern, consisting of epithelial glandular structures which showed a gradual transition into a spindle-cell tumour, resembling a neurogenic tumour. The neoplasm was considered malignant since it had infiltrated into the muscular layer of the duodenal wall. The tumour was non-argentaffin and non-argyrophil. No serotonin could be demonstrated histochemically. Immunoreactive pancreatic polypeptide (HPP) was detected by indirect immunofluorescence in the majority of tumour cells of the epithelial glandular structures, whereas areas with a spindle-cell pattern were almost unreactive to the HPP-antiserum. No reaction was found with antibodies against gastrin, insulin, glucagon, vasoactive intestinal polypeptide or somatostatin. The patient had no endocrine symptoms that could be ascribed to the production of HPP by the neoplasm. Twenty-four months postoperatively, the patient's serum HPP concentration had begun to rise, suggesting recurrence of the tumour.

Ampulla of Vater↗
PubMed1981

Hypotonic duodenography and secretin-CCK test in the diagnosis of pancreatic disease.

Sixty-five patients with possible pancreatic disease or long-lasting upper abdominal symptoms were examined by means of the secretin-CCK test and hypotonic duodenography. Both examinations were performed after one duodenal intubation. In patients with pancreatitis functional abnormalities were revealed in 85 per cent while the duodenography was abnormal in 43 per cent. In patients with carcinoma, 77 per cent had abnormal exocrine pancreas function and 70 per cent had abnormalities demonstrated at duodenography. The value of the two examinations for assessment of patients with upper abdominal symptoms and pancreatic disease is discussed.

Adult↗
PubMed1981

Hypotonic duodenography and endoscopic retrograde pancreatography in the diagnosis of pancreatic disease.

Hypotonic duodenography and endoscopic retrograde pancreatography were performed in 45 non-icteric patients with suggested pancreatic disease or long-standing upper gastrointestinal symptoms. The accuracy of each method in the diagnosis of pancreatic disease was compared. Hypotonic duodenography revealed pancreatitis in 48 per cent and ERP in 83 per cent of the cases. All 6 pancreatic tumours were detected at ERP and 3 at duodenography. The role of hypotonic duodenography and endoscopic retrograde pancreatography in the diagnosis of pancreatic disease is discussed.

Adult↗
PubMed1981

C-peptide concentration in pancreatic juice obtained during endoscopic pancreatography in patients with and without insulinoma.

ERCP was performed in three patients with insulinoma. One had a large malignant tumor, while the remaining two had small tumours. In two of these patients pancreatic juice was collected for C-peptide determination. Pancreatography was performed and pancreatic juice was obtained in seven other subjects comprising: five control subjects and two patients in whom insulinoma was suspected because of symptoms suggestive of hypoglycaemia. Pancreatography was normal in all subjects except the patient with a large insulinoma in whom an obstruction of the main pancreatic duct was found. The maximal C-peptide concentrations in pancreatic juice of patients with insulinoma were found to be several-fold higher than in the control subjects and in one of the patients in whom insulinoma was suspected but unproven. The remaining patient with suspected insulinoma had a maximal C-peptide concentration comparable with those found in patients with proven insulinoma. Thus remarkable differences in maximal C-peptide concentrations obtained in patients with and without insulinoma were found. However, the clinical significance of the findings needs further evaluation. The value of ERP in patients with suspected insulinoma may be twofold: an obstruction of the main pancreatic duct may indicate a large, hardly resectable tumour; in patients in whom the duct is unaffected the relation between the tumour as visualized by angiography, and the duct, is of value for the surgeon when planning the operation.

Adenoma, Islet Cell↗
PubMed1980

Exocrine pancreatic function, fecal fat, and blood glucose in patients with pancreatitis.

Exocrine pancreatic function, as revealed by bicarbonate output after secretion stimulation and trypsin output after CCK stimulation, fecal fat excretion, and glucose tolerance were studied in 40 patients with pancreatitis. A high fecal fat excretion and an abnormal glucose tolerance were found in about three quarters of the patients with markedly reduced bicarbonate output (less than 0.15 mmol . h-1 . kg-1). Normal fecal fat excretion was observed in five of six and normal glucose tolerance in all patients who had a normal bicarbonate output (greater than 0.30 mmol . h-1 . kg-1). All of the patients with abnormal glucose tolerance had impaired bicarbonate output. The trypsin output after CCK stimulation was not more closely related either to the fecal fat excretion or to the glucose tolerance.

Adult↗