Biomedical subjects

R Gullichsen

Publications and source records attributed to R Gullichsen.

18 recordsLinked to original sources

PubMed2006

Long-acting octreotide in the treatment of diarrhea after pelvic pouch surgery.

After pelvic pouch surgery (restorative proctocolectomy), periodic or continuous diarrhea is common. Distressing diarrhea may be triggered by pouchitis, cuffitis or an anastomotic stricture. Medical therapy with loperamide or diphenoxylate is often unsatisfactory even after the correction of the underlying problem. Seven patients, who earlier had undergone restorative proctocolectomy, were treated with a standard dose of 10 mg of long-acting octreotide (Sandostatin LAR) for prolonged and distressing diarrhea which had not responded to conventional medication. Five of the patients had complete relief of diarrhea. The effect lasted for at least two months after a single dose. Two patients did not respond. No sideeffects were reported. Long-acting octreotide is effective in the treatment of severe diarrhea in patients after pelvic pouch surgery.

Adult↗

PubMed2005

Needle-knife assisted ERCP.

BACKGROUND: During endoscopic retrograde cholangiopancreatography (ERCP), incising through the wall of the major papilla with an electrocautery needle-knife is a method for achieving access into the bile duct. This procedure, often referred to as a "precut," may be used when cannulation attempts via the orifice of the papilla are unsuccessful. Potential complications include hemorrhage, duodenal perforation, and acute pancreatitis. METHODS: The 172 patients who underwent an attempt of a needle-knife assisted ERCP during the years 1997-2003 at our institution were retrospectively evaluated. RESULTS: A selective bile duct cannulation was achieved after needle-knife incision in 148 out of 172 patients (86%) at the primary session. In 10 additional patients (6%), a repeated procedure proved successful for cannulation. In the remaining 14 patients (8%), the biliary cannulation failed and was not attempted again. Complications after needle-knife assisted ERCP occurred as follows: three patients (2%) presented with late bleeding after the ERCP and three patients (2%) developed acute pancreatitis. None of the patients required operative treatment for complications. There was no mortality. CONCLUSION: The use of the needle-knife markedly improves the success rate of selective biliary cannulation in ERCP without increasing the rate of complications.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed2001

Effect of the diameter of the common bile duct on the incidence of bile duct stones in patients with recurrent attacks of right epigastric pain after cholecystectomy.

OBJECTIVE: To study the relationship between the diameter of the common bile duct and the incidence of bile duct stones in non-jaundiced patients with recurrent attacks of right epigastric pain after cholecystectomy. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 57 consecutive, non-jaundiced patients admitted for elective endoscopic retrograde cholangiopancreatography (ERCP) because of attacks of right epigastric pain after cholecystectomy. INTERVENTIONS: Measurement of maximum diameter of the common bile duct and presence or absence of bile duct stones. MAIN OUTCOME MEASURES: Diameter of bile duct (10 mm or less was regarded as normal) and presence or absence of stones. RESULTS: 33 patients had normal-sized bile ducts and in 24 they were widened. Only 2/33 patients with normal-sized ducts (6%) had stones, compared with 11/24 (46%) with wide ducts (p = 0.0008). However, the degree of ductal dilatation did not seem to have any influence on the presence or absence of stones. CONCLUSION: Bile duct stones are unlikely after cholecystectomy in patients who are not jaundiced and have a normal-sized common bile duct. However, nearly half of the patients with a wide common bile duct had stones, but the degree of dilatation was not important.

Abdominal Pain↗

PubMed2001

A non-icteric cholecystectomized patient with recurrent attacks of right epigastric pain and dilated common bile duct--do liver function tests predict bile duct stones?

Cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct are a clinical challenge. In a number of these patients dilatation of the common bile duct is explained as a normal postoperative state following cholecystectomy and the recurrent pain attacks are of origin other than bile disorder, but in some cases dilatation of the common bile duct and attacks are caused by bile duct stones. The aim of the present work was to study the value of common plasma liver function tests in predicting bile duct stones in the group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. The study population comprised 24 consecutive non-icteric cholecystectomized patients admitted for elective endoscopic retrograde cholangiopancreatography because of attacks of right epigastric pain and dilated common bile duct in ultrasonography. All the liver function tests seemed to assist in separating patients with bile duct stones (n=11) from those without (n=13). Alanine aminotransferase levels were significantly higher (p=0.05) in patients with bile duct stones than in those without, but also alkaline phosphatase (p=0.07), gamma-glutamyl transferase (p=0.09) and bilirubin (p=0.09) levels seemed to be higher in patients with bile duct stones than in those without, although the differences in these values did not reach statistical significance. In conclusion, common plasma liver function tests assist in separating patients with bile duct stones from those without in this small but clinically important group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. However, the actual value of these measurements is limited in clinical decision making since overlapping of values occured.

Adult↗

PubMed1999

Laparoscopy for chronic abdominal pain.

The purpose of this study was to evaluate the usefulness of exploratory laparoscopy in patients with chronic abdominal pain. Forty-six patients underwent diagnostic laparoscopy for abdominal pain of unknown origin during 1992-1996. The average duration of the symptoms was 3.5 years. Patients with known malignancy were excluded. Seventy-two percent of the patients had undergone previous abdominal or groin surgery. An organic disease was found in 68% of the laparoscopies. Adhesions were found in 29 patients, inguinal hernia in 2 patients, and abnormal mesenteric lymph nodes in 1 patient. Adhesiolysis was carried out in 24 patients. Eighty-nine percent of patients could be contacted for follow-up. Mean follow-up time was 19 months. Seventy-seven percent of patients who had undergone adhesiolysis considered the result good or beneficial. Sixty percent of all patients reported a beneficial outcome after laparoscopy. No major complications were noted. This retrospective study suggests that laparoscopy is a safe and useful procedure in the diagnosis and treatment of chronic abdominal pain.

Abdominal Pain↗

PubMed1998

The distribution of collagen types I, III, and IV in normal and malignant colorectal mucosa.

OBJECTIVE: To compare the distribution of interstitial collagens (type I and III) and basement membrane collagen (type IV) in cancerous and normal colon. DESIGN: Retrospective study. SETTING: University hospital, Finland. SUBJECTS: 13 patients with colorectal cancer of different stages and grades. MAIN OUTCOME MEASURES: Indirect immunofluorescence labelling for type I, III, and IV collagens of fresh frozen tissue samples, both normal and cancerous, cut into serial sections 6 microm thick. RESULTS: In normal mucosa, the epithelial basement membrane showed an intense immunoreaction for type IV collagen. Type I and III collagens were localised to the interstitial stroma underlying it. The membrane in cancer samples was characterised by discontinuities and thinning as estimated by immunolabelling for type IV collagen. Furthermore, immediately adjacent to the membrane type I and III collagen positivity was fragmented. The cancerous stroma showed a strong positive immunosignal for type I and III collagens. CONCLUSION: Both the epithelial basement membrane and the collagenous matrix immediately beneath it are degraded in malignant tissue. This may suggest the simultaneous activation of several degradative enzymes (as type I and III collagens are at least in part degraded by different enzymes from type IV collagen) or alterations in the expression of collagen subtypes in normal compared with malignant tissue.

Collagen↗

PubMed1997

Laparoscopic appendectomy-is it worthwhile? A prospective, randomized study in young women.

BACKGROUND: Clinical diagnosis of acute appendicitis is most difficult in fertile-age women. In this patient group up to 50% of open appendectomies are negative for appendicitis. We conducted a randomized study to compare laparoscopic and open appendectomy in young female patients with suspected acute appendicitis. METHODS: Fifty female patients between the ages of 16 and 40 years presenting with acute right lower abdominal pain were randomized, 25 to laparoscopy and 25 to an open appendectomy. Diagnostic accuracy, rate of negative appendectomies, safety, and final outcome were compared in the two groups. RESULTS: Diagnosis was established in 96% of patients in the laparoscopic group and in 72% in the open group. There were 11 (44%) unnecessary appendectomies in the open group, but only one (4%) in the laparoscopic group (p < 0.0005). CONCLUSIONS: In young women with right lower abdominal pain, laparoscopy can give precise diagnosis and reduce the rate of negative appendectomies.

Adolescent↗

PubMed1997

Laparoscopic vs conventional Nissen fundoplication. A prospective randomized study.

BACKGROUND: Laparoscopic Nissen fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure have not been compared to the results of an open fundoplication in a randomized study. METHODS: Some 110 consecutive patients with prolonged symptoms of grade II-IV esophagitis were randomized, 55 to laparoscopic (LAP) and 55 to an open (OPEN) Nissen fundoplication. Postoperative recovery, complications, and outcome at 3- and 12-month follow-up were compared in the two groups. RESULTS: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical difficulties (two), and bleeding (one). In the OPEN group (two) patients underwent splenectomy. There was no mortality. The mean hospital stay was 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months after the operation in both groups. These symptoms had disappeared at the 12-month follow-up examination. All patients in the LAP group and 86% in the OPEN group were satisfied with the result. CONCLUSIONS: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good if not better than those of conventional open surgery.

Adult↗

PubMed1996

Laparoscopic removal of the acutely inflamed gall bladder.

Seventy-six patients underwent laparoscopic cholecystectomy for acute cholecystitis between June 1991 and April 1995 at our clinic and were retrospectively reviewed. Seventy per cent of the operations could be completed laparoscopically with uneventful recovery. In 15 cases the procedure was converted into an open one. Three patients had to be reoperated, one of them died in myocardial infarction three weeks after the reoperation. The mean operative time was 95 minutes (range 45-180). The average postoperative hospitalisation was 3.1 days. The laparoscopic method is suitable for removal of the acutely inflamed gall bladder. The procedure is more difficult and time-consuming than in elective cases, and conversion are more frequent.

Acute Disease↗

PubMed1995

Laparoscopic Nissen fundoplication. Initial experience.

Fifty-two patients underwent laparoscopic Nissen fundoplication. Oesophagogastroscopy, ambulatory 24-hour pH-recording and oesophageal manometry were evaluated both preoperatively and at follow-up. Forty-seven operations were completed laparoscopically, five were converted to laparotomy. There was no mortality, but minor postoperative complications occurred in four patients. The mean hospital stay after a laparoscopic operation was three days and sick leave 14 days. After three months, 94% of the patients were free of reflux symptoms, oesophagogastroscopy showed normal findings in 95% of the patients and oesophageal 24-hour pH-values were normal in 95% of the patients. Dysphagia (28%) and gas bloating (17%) were the most frequent postoperative complaints. A total of 94% of the subjects were satisfied with the result. Our initial experience of laparoscopic Nissen fundoplication shows that the operation is safe and efficient in the treatment of gastro-oesophageal reflux disease.

Adult↗

PubMed1993

What happens to the Valtrac anastomosis of the colon? A follow-up study.

Late results after colonic anastomoses performed with the biofragmentable anastomosis ring (BAR; Valtrac; Davis & Geck, Wayne, NJ) were evaluated in 30 patients who had undergone a left-sided colonic or rectosigmoid anastomosis a mean of 24.5 (range, 12-38) months earlier. Patients were asked about their late postoperative recovery and their bowel habits. A barium enema was performed, and then a flexible endoscopy was done, during which the anastomotic area was evaluated both in macroscopic terms and histologically. One of the patients had died, and three refused to participate in the investigation. Of the remaining 26 patients, one had been reoperated on 22 months after the primary sigmoid resection. The reason for reoperation was an anastomotic stricture. One of the patients was admitted to the hospital during the study and was operated on for reasons not related to the anastomosis. Twenty-four patients underwent the study scheme. All had recovered uneventfully. Sixteen anastomoses could not be identified radiologically and seven not even during endoscopy. Histologically, there was mild-to-moderate fibrosis and scarring in 17 anastomoses, and, in the seven that could not be identified, only normal colonic mucosa was found. The late results of BAR anastomoses are satisfying, and the rate of complications is acceptable.

Adult↗

PubMed1993

The biofragmentable ring in intestinal surgery.

The Biofragmentable Anastomosis Ring (BAR) is a device, which originally has been designed for sutureless large bowel anastomoses. In this study, the method is evaluated in comparison with sutured and stapled anastomoses through experimental surgery. Clinical results of colonic BAR anastomoses are compared to those gained by sutured anastomoses. New applications of the anastomosis ring: small bowel anastomoses and cholecystojejunostomies are introduced in clinical trials. Fourteen dogs had a laparotomy with three consequent colonic transections. These were anastomosed; one by manual suture, one with a circular stapler and one with the BAR. On day 1, 3, 5, 7, or 40, postoperatively, the animals were sacrificed, and each operated colonic segment was removed for examination. In four animals dilation of the bowel was seen proximal to the BAR anastomosis. No clinical obstruction had been noted in them, however. Up to the seventh postoperative day, edematous and inflamed mucosa was observed with the BAR, and the least reaction was connected to the stapled anastomoses. Forty days after the operation all the three types of anastomoses had healed equally well both macroscopically and histologically. One hundred and fifty patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture and 79 were fitted with the BAR. Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage. During follow up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract and the hospital stay were similar in the two groups. The late results after colonic anastomoses performed with the BAR were evaluated in 26 patients who had undergone a left sided colonic or rectosigmoid anastomosis. One had been operated on for an anastomotic stricture 22 months after the initial operation, which was a sigmoid resection. One had been operated during the study for reasons not related to the anastomosis. 24 patients underwent the study scheme. In 16 of the patients, the anastomosis could not be radiologically identified, and in seven not even during endoscopy. Histologically there was mild to moderate fibrosis and scarring in 17 anastomoses and in the seven that could not be identified, only normal colonic mucosa was found. Of one hundred and seventy patients undergoing upper gastrointestinal surgery, 81 had the jejunojejunal enteroanastomosis done with the BAR and 89 patients received sutures. Both end-to-side (101 patients) and side-to-side reconstructions (69 patients) were done. Neither ruptures nor obstructions of the enteroanastomosis occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1992

Colonic anastomosis using the biofragmentable anastomotic ring and manual suture: a prospective, randomized study.

One hundred and fifty consecutive patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture with a two-layer anastomosis of resorbable suture material (3/0 Dexon) and 79 were fitted with the biofragmentable anastomotic ring (Valtrac-BAR). Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage which required a Hartmann-type reoperation. This was successful in four; one patient in the suture group died after reoperation. One patient who underwent suture had an early anastomotic stricture with fatal sequelae. Three other patients (one in the BAR group and two in the suture group) died after operation from other causes. Thus the mortality rate was 6 per cent in the suture group and 1 per cent in the BAR group. During follow-up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract was similar in the two groups regarding duration of nasogastric drainage, intravenous fluid therapy and ileus. There was no difference between the groups in duration of hospital stay. The BAR seems to be a safe and reliable alternative to conventional suture anastomosis in colonic surgery.

Aged↗

PubMed1992

Immunohistochemical characterization of an amphicrine mucinous islet-cell carcinoma of the pancreas. Case report.

Immunohistochemical characteristics of a mucinous islet-cell carcinoma of the pancreas are described. The tumour presented with jaundice in a 59-year-old male. It consisted of polygonal atypical cells forming a reticular pattern, and invaded the common bile duct. In DNA flow cytometry, the tumour cells showed a clear-cut aneuploid peak. Intercellular mucin was abundant. A panel of antisera and monoclonal markers was applied in the immunohistochemical analysis. In addition to general epithelial and endocrine markers, the tumour cells showed a focal positive immunoreaction with anti-glucagon, anti-insulin, anti-vasoactive intestinal polypeptide, anti-pancreatic secretory trypsin inhibitor and anti-phospholipase A2 antigen. At the ultrastructural level, mucous and neuroendocrine granules were demonstrated in the same tumour cells.

Adenoma, Islet Cell↗

PubMed1992

Laparoscopic cholecystectomy. Experience of the first 150 patients.

Between April 1991 and May 1992, 150 patients were treated by laparoscopic cholecystectomy. Eleven patients (7.3%) required conversion to open laparotomy and five (3.3%) patients were operated on for postoperative complications. There were two (1.3%) patients with a hepatic duct lesion, one of which was treated with a T-tube alone but the other required a bilioenteral reconstruction. The average operation time was 72 minutes (range 30-240 minutes). The mean hospital stay of all patients was 2.1 days (range 1-28 days) and the mean time to return to work was 11.5 days (range 6-60 days).

Adolescent↗

PubMed1992

Cholecystoenteral anastomosis with the biofragmentable ring and manual suture--a prospective, randomized study.

20 patients treated by cholecystojejunostomy for obstructive icterus were randomized to be treated either with a biofragmentable intraluminal ring (Valtrac) (10 patients) or suture of the cholecystointestinal anastomosis (10 patients). Postoperatively one patient in each group died of advanced malignancy. There were no surgical complications in either group. The relief of icterus, recovery of the gastrointestinal tract and the mean hospital stay were similar in both groups. The biofragmentable anastomosis ring (BAR) is a safe method for cholecystoenteral anastomoses.

Adult↗

PubMedDate not supplied

Small bowel anastomosis with the biofragmentable anastomosis ring and manual suture: a prospective, randomized study.

A total of 170 patients undergoing upper gastrointestinal surgery requiring a jejuno-jejunal enteroanastomosis were randomized into two groups according to the method to be employed at the enteroanastomosis. The most common procedures were partial gastrectomy for benign disease (84 patients), partial or total gastrectomy for malignant disease (35 patients), and bilioenteral bypass (31 patients, 25 for malignant disease). The enteroanastomosis was created by manual suture (3-0 Dexon, two layers) in 89 patients and with the Biofragmentable Anastomosis Ring (Valtrac-BAR) in 81 patients. Both end-to-side (101 patients) and side-to-side (69 patients) reconstructions were done. No ruptures or obstructions of the jejuno-jejunal anastomosis occurred. The postoperative recovery of the gastrointestinal tract was similar in the two groups in duration of nasogastric drainage, intravenous fluid therapy, and intestinal paralysis. Nor was there any difference between the groups in the duration of the postoperative hospital stay. Ten patients, 7 in suture-group and 3 in BAR-group, died postoperatively of causes unrelated to the enteroanastomosis. Thus the mortality rate was 7.9% in the suture group and 3.7% in the BAR group. The biofragmentable ring offers a safe alternative to manual sutures for small bowel anastomoses.

Anastomosis, Surgical↗

PubMedDate not supplied

Polyarteritis nodosa of the descending colon. Case report.

A 28-year-old man presented with fulminant, haemorrhagic, left-sided colitis, that was thought to be Crohn's disease both clinically and macroscopically. Histopathological examination, however, showed polyarteritis nodosa. The patient had no other signs of this disease, which should be added to the differential diagnoses of colitis.

Adult↗