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Biomedical subjects

R E Andersson

Publications and source records attributed to R E Andersson.

15 recordsLinked to original sources
PubMed2006

Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis.

Appendicitis is one of the most common and costly acute abdominal states of illnesses. Previous studies suggest two types of appendicitis which may be different entities, one which may resolve spontaneously and another that progresses to gangrene and perforation. Gangrenous appendicitis has a positive association to states of Th1 mediated immunity whereas Th2 associated immune states are associated with lower risk of appendicitis. This study investigated the inflammatory response pattern in patients previously appendicectomized for gangrenous (n = 7), or phlegmonous appendicitis (n = 8) and those with a non-inflamed appendix (n = 5). Peripheral blood mononuclear cells were analysed with ELISPOT analysis for number of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-4, IL-10 and IL-12 secreting cells or with ELISA for concentration of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-5 and IL-10. Spontaneously IL-10 secreting cells/100,000 lymphocytes were increased in the gangrenous group compared to the phlegmonous group (P = 0.015). The median concentration of IL-10 secreted after Tetanus toxoid (TT)-stimulation were higher in the gangrenous group and the control group, than the phlegmonous group (P = 0.048 and P = 0.027, respectively). The median concentration of TT induced IFN-gamma secretion was higher for the gangrenous group compared to both the phlegmonous group and the control group (P = 0.037 and P = 0.003). Individuals with a history of gangrenous appendicitis demonstrated ability to increased IL-10 and IFN-gamma production. The increased IFN-gamma may support the notion of gangrenous appendicitis as an uncontrolled Th1 mediated inflammatory response and increased IL-10 may speculatively indicate the involvement of cytotoxic cells in the progression to perforation.

Adolescent↗
PubMed2001

Appendectomy and protection against ulcerative colitis.

BACKGROUND: A history of appendectomy is rare in patients with ulcerative colitis. This suggests a protective effect of appendectomy or that appendicitis and ulcerative colitis are alternative inflammatory responses. We sought to characterize this inverse relation further. METHODS: We studied a cohort of 212,963 patients who underwent appendectomy before the age of 50 years between 1964 and 1993 and a cohort of matched controls who were identified from the Swedish Inpatient Register and the nationwide census. The cohort was followed until 1995 for any subsequent diagnosis of ulcerative colitis. RESULTS: Patients who underwent appendectomy for appendicitis and mesenteric lymphadenitis had a low risk of ulcerative colitis (for patients with perforated appendicitis, the adjusted hazard ratio was 0.58 [95 percent confidence interval, 0.38 to 0.87]; for those with nonperforated appendicitis it was 0.76 [95 percent confidence interval, 0.65 to 0.90]; and for those with mesenteric lymphadenitis it was 0.57 [95 percent confidence interval, 0.36 to 0.89]). In contrast, patients who underwent appendectomy for nonspecific abdominal pain had the same risk of ulcerative colitis as the controls (adjusted hazard ratio, 1.06; 95 percent confidence interval, 0.74 to 1.52). For the patients who had appendicitis, an inverse relation with the risk of ulcerative colitis was found only for those who underwent surgery before the age of 20 years (P<0.001). CONCLUSIONS: Appendectomy for an inflammatory condition (appendicitis or lymphadenitis) but not for nonspecific abdominal pain is associated with a low risk of subsequent ulcerative colitis. This inverse relation is limited to patients who undergo surgery before the age of 20 years.

Abdominal Pain↗
PubMed2001

Identification of a sucrose diester of a substituted beta-truxinic acid in oats.

A novel compound, 4,4'-dihydroxy-3,3'-dimethoxy-beta-truxinic acid esterified to sucrose through the fructosyl 3-and 6-carbons (1), was isolated from oat grains (Avena sativa L.). Its structure was determined by a combination of mass spectrometry and 1-D and 2-D NMR. The amounts of 1 in groats of six different oat cultivars ranged from 101 to 150 microg g(-1) (dry wt). None was detected in the hulls. The free diacid, 4,4'-dihydroxy-3,3'-dimethoxy-beta-truxinic acid (2), could not be detected in groats nor in hulls.

Avena↗
PubMed2001

Small bowel obstruction after appendicectomy.

BACKGROUND: This study analysed the risk of surgically treated small bowel obstruction after open appendicectomy. METHODS: This was a historical cohort study of 245 400 patients who underwent open appendicectomy and population-based matched controls, identified by linkage of computer registries. Analyses were made with the life-table technique, Kaplan-Meier plots and Cox proportional hazards regression analysis. RESULTS: The cumulated risk of surgically treated small bowel obstruction after appendicectomy was 0.41 per cent after 4 weeks, 0.63 per cent after 1 year and 1.30 per cent after 30 years of follow-up, compared with 0.003 per cent at 1 year and 0.21 per cent after 30 years of follow-up among the non-operated controls. The highest risk was found after operation for other diagnoses (adjusted hazard ratio 5.2 (95 per cent confidence interval 4.6-5.8)), followed by operation for perforated appendicitis (adjusted hazard ratio 3.5 (3.1-3.8)), non-specific abdominal pain (adjusted hazard ratio 2.6 (2.3-3.0)) and mesenteric lymphadenitis (adjusted hazard ratio 2.4 (2.0-2.8)) compared with operation for non-perforated appendicitis. The relation with age was J shaped, with the lowest risk at 20-39 years. Women had a slightly lower risk than men. CONCLUSION: The risk of postoperative small bowel obstruction needing surgical treatment after open appendicectomy is lower than previously thought. Perforated appendicitis, negative appendicectomy and high age are the risk factors.

Adult↗
PubMed2001

Incidence of appendicitis during pregnancy.

BACKGROUND: The aetiology and pathogenesis of appendicitis remains unknown. A relation with female sex hormones has been proposed because of a lower incidence among women and incidence variations during the menstrual cycle, but studies have given inconsistent results. Pregnancy constitutes a period of dramatic increases in levels of female sex hormones, but the incidence of appendicitis during childbearing is not known. METHODS: Case-control study of pregnancy status at the time of appendectomy of 53 058 women and of 53 058 population-based age-matched controls. Cases and controls were identified by linkage of the Swedish Inpatient Register and the nation-wide census. Pregnancy status at the time of operation was obtained by linkage with the Swedish Fertility Register. Differences in pregnancy status were analysed using conditional logistic regression and expressed as odds ratios (OR) with 95% CI. RESULTS: Fewer patients than expected with appendicitis were pregnant compared with the controls, especially in the third trimester (OR = 0.49, 95% CI : 0.30-0.79 for perforated and OR = 0.33, 95% CI : 0.28-0.39 for non-perforated appendicitis). CONCLUSIONS: The reduced incidence of appendicitis suggests a protective effect of pregnancy, especially in the third trimester.

Adult↗
PubMed2001

Mortality after appendectomy in Sweden, 1987-1996.

OBJECTIVE: To study mortality after appendectomy. SUMMARY BACKGROUND DATA: The management of patients with suspected appendicitis remains controversial, with advocates of early surgery as well as of expectant management. Mortality is not known. METHODS: The authors conducted a complete follow-up of deaths within 30 days after all appendectomies in Sweden (population 8.9 million) during the years 1987 to 1996 (n = 117,424) by register linkage. The case fatality rate (CFR) and the standardized mortality ratio (SMR) were analyzed by discharge diagnosis. RESULTS: The CFR was 2.44 per 1,000 appendectomies. It was strongly related to age (0.31 per 1,000 appendectomies at 0-9 years of age, decreasing to 0.07 at 20-29 years, and reaching 164 among nonagenarians) and diagnosis at surgery (0.8 per 1,000 appendectomies after nonperforated appendicitis, 5.1 after perforated appendicitis, 1.9 after appendectomies for nonsurgical abdominal pain, and 10.0 for those with other diagnoses). The SMR showed a sevenfold excess rate of deaths after appendectomy compared with the general population. The relation to age was less marked (SMR of 44.4 at 0-9 years, decreasing to 2.4 in patients aged 20-29 years. and reaching 8.1 in nonagenarians). The SMR was doubled after perforation compared with nonperforated appendicitis (6.5 and 3.5, respectively). Nonsurgical abdominal pain and other diagnoses were associated with a high excess rate of deaths (9.1 and 14.9, respectively). The most common causes of deaths were appendicitis, ischemic heart diseases and tumors, followed by gastrointestinal diseases. CONCLUSIONS: The CFR after appendectomy is high in elderly patients. The excess rate of death for patients with nonperforated appendicitis and nonsurgical abdominal pain suggests that the deaths may partly be caused by the surgical trauma. Increased diagnostic efforts rather than urgent appendectomy are therefore warranted among frail patients with an equivocal diagnosis of appendicitis.

Adult↗
PubMed2000

Repeated clinical and laboratory examinations in patients with an equivocal diagnosis of appendicitis.

In-hospital observation with repeated clinical examinations is commonly used in patients with an equivocal diagnosis of appendicitis. It is not known if repeated measurements of temperature and laboratory examinations have any diagnostic importance in this situation. The importance of repeated measurements of the body temperature, white blood cell (WBC) and differential cell counts, C-reactive protein concentration (CRP) and of the surgeon's repeated assessments was prospectively analyzed in 420 patients with an equivocal diagnosis of appendicitis at admission who were reexamined after a median of 6 hours of observation. The final diagnosis was appendicitis in 137 patients. After observation the inflammatory response was increasing among patients with appendicitis and decreasing among patients without appendicitis. The variables discriminating power for appendicitis consequently increased, from an area under the receiver operating characteristic (ROC) curve of 0.56 to 0.77 at admission, to 0.75 to 0.85 after observation. The ROC area of the surgeons' clinical assessment increased from 0.69 to 0.89. The WBC and differential cell counts were the best discriminators at the repeat examination. The change in the variables between the observations had weak discriminating power and had no additional importance in addition to the actual level at the repeat examination. To conclude, the diagnostic information of the temperature and laboratory examinations increased after observation. Repeated controls of the body temperature and laboratory examinations are therefore useful in the management of patients with equivocal signs of appendicitis, but the result of the examinations must be integrated with the clinical assessment.

Adolescent↗
PubMed2000

Why does the clinical diagnosis fail in suspected appendicitis?

OBJECTIVE: To identify systematic errors in surgeons' estimations of the importance of diagnostic variables in the decision to explore patients with suspected appendicitis. DESIGN: Prospective case series. SETTING: Two emergency departments, Sweden. PATIENTS: 496 patients with suspected appendicitis on admission, of whom 194 had a correct operation for appendicitis and 59 had a negative exploration. MAIN OUTCOME MEASURES: Predictors of a negative exploration expressed as the odds ratio (OR) for negative exploration. Variables influence on the decision to operate, expressed as the OR for operation, compared with the true diagnostic importance, expressed as the OR for appendicitis. RESULTS: Predictors of negative explorations were high ratings in variables describing pain and tenderness (patient's perceived pain, abdominal tenderness, rebound tenderness, guarding or rectal tenderness), weak or absent inflammatory response, female sex, long duration of symptoms and absence of vomiting, with OR of 1.8-3.0. Pain and tenderness had too strong an influence on the decision to operate whereas the lack of an inflammatory response, no vomiting, and long duration of symptoms were not given enough attention. There was no sex difference in the proportion of patients with non-surgical abdominal pain (NSAP) who were operated on, but NSAP was more common and appendicitis less common among women, leading to a larger proportion of negative appendicectomies among women. CONCLUSION: Negative explorations in patients with suspected appendicitis are related to systematic errors in the clinical diagnosis with too strong an emphasis on pain and tenderness, and too little attention paid to duration of symptoms and objective signs of inflammation. Rectal tenderness is not a sign of appendicitis. The risk of diagnostic errors is similar in men and women.

Abdominal Pain↗
PubMed1999

Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis.

The clinical diagnosis of appendicitis needs to be improved, as up to 40% of explorations for suspected appendicitis are unnecessary. The use of body temperature and laboratory examinations as diagnostic aids in the management of these patients is controversial. The diagnostic power of these variables compared to that of the disease history and clinical findings is not well studied. In this study we prospectively assessed and compared the diagnostic value of 21 elements of the history, clinical findings, body temperature, and laboratory examinations in 496 patients with suspected appendicitis. The diagnostic value of each variable was compared from the area under the receiver operating characteristic (ROC) curve and the likelihood ratios (LR). Logistic regression was used to analyze the diagnostic value of a combination of variables and to analyze independent relations. No single variable had sufficiently high discriminating or predicting power to be used as a true diagnostic test. The inflammatory variables (temperature, leukocyte and differential white blood cell (WBC) counts, C-reactive protein) had discriminating and predicting powers similar to those of the clinical findings (direct and rebound abdominal tenderness and guarding). Anorexia, nausea, and right-sided rectal tenderness had no diagnostic value. The leukocyte and differential WBC counts, C-reactive protein, rebound tenderness, guarding, and gender were independent predictors of appendicitis with a combined ROC area of 0. 93 for appendicitis. This showed that inflammatory variables contain important diagnostic information, especially with advanced appendicitis. They should therefore always be included in the diagnostic workup in patients with suspected appendicitis.

Abdominal Pain↗
PubMed1992

Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate.

OBJECTIVE: To see if diagnostic accuracy and perforation rate in acute appendicitis is associated with age and sex of the patients and with the appendicectomy rate. DESIGN: Retrospective study of consecutive patients from a defined population. Study of associations between diagnostic accuracy and perforation rate and appendicectomy rate in published reports. SETTING: Jönköping county, Sweden. SUBJECTS: 3,029 patients operated on for suspected acute appendicitis from 1984-1989. MAIN OUTCOME MEASURES: Findings at laparotomy for acute appendicitis, confirmed with histological examination in 83% of the cases. RESULTS: Diagnostic accuracy was low at the extremes of age and in women (60% compared with 79% in men, p less than 0.001). When all intra-abdominal conditions were considered the percentage of negative laparotomies among women (24%) was twice that among men (12%, p less than 0.001). This difference between the sexes was also seen in nonfertile ages. Perforation rate was higher among men (18% compared with 13%, p less than 0.01) and at extremes of age. According to correlation analysis of published reports the perforation rate is unrelated to either diagnostic accuracy or appendicectomy rate while diagnostic accuracy is inversely associated with the appendicectomy rate. CONCLUSION: A low diagnostic accuracy is a problem mainly at extremes of age and in females. A low appendicectomy rate is associated with a high diagnostic accuracy, while the perforation rate is unaffected. A conservative attitude to exploration therefore seems justified.

Adult↗
PubMed1988

Antibacterial activity of plantaricin SIK-83, a bacteriocin produced by Lactobacillus plantarum.

Lactobacillus plantarum SIK-83 produces a bacteriocin, designated plantaricin SIK-83, which inhibits 66 of 68 lactic acid bacteria from the genera Lactobacillus, Leuconostoc, Pediococcus and Streptococcus. A 500-fold dilution of L. plantarum SIK-83 MRS culture supernatant with phosphate buffer was sufficient to kill 10(5) cells/ml of Pediococcus pentosaceus within 120 s. The killing of a sensitive population followed exponential kinetics. It was shown that the bacteriocin binds specifically to sensitive cells but not to nonsensitive lactic acid bacteria, the producer strain or Gram-negative bacteria. Sensitive cells, after exposure to the bacteriocin, could be rescued by treatment with proteolytic enzymes. In buffer, plantaricin SIK-83 was adsorbed to the cell surface almost immediately, and morphological lesions were observed within 2 h after the cells were exposed to the bacteriocin. The lethal mode of action appeared to be due to damage to the cell membrane, resulting in cell lysis, which was detected by electron microscopy and by determination of released intracellular components.

Adsorption↗
PubMed1980

Microbial lipolysis at low temperatures.

It was found that lipase production during the growth of Pseudomonas fluorescens was not a function of the total number of bacteria. The optimal temperatures for bacterial growth and lipase production were determined as 20 and 8 degrees C, respectively. The lipolytic activity was studied in emulsions of olive oil at temperatures ranging from +8 to -30 degrees C. After an initially rapid lipolysis, the reactions retarded at different levels depending on storage temperature. Transference to a higher temperature resulted in a resumed lipolysis. Also, at low temperatures, lipolysis was studied as a function of water activity and was found to occur in dehydrated substrates.

Cold Temperature↗
PubMed1979

Thermal inactivation of a heat-resistant lipase produced by the psychotrophic bacterium Pseudomonas fluorescens.

Lipase from Pseudomonas fluorescens was studied for thermostability at temperatures ranging from 100 C to 160 C. The heat treatments were in two media, and heating times necessary to inactivate 90% of the enzyme at constant temperature were extremely long even at high temperatures, e.g. 3.6 min at 140 C in nutrient broth and 2.0 min at 170 C in skim milk. The increments of temperature to reduce these heating times 90% were 37.0 C in nutrient broth and 38.9 C in skim milk. The lipase was inactivated only partly after 20 h at 20 C in 8 M urea, 6 M guanidine hydrochloride, and 1.0% sodium dodecyl sulfate. Four percent 2-mercaptoethanol showed no effect.

Animals↗