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S Genell

Publications and source records attributed to S Genell.

At least 19 recordsLinked to original sources
PubMed1999

New sonographic imaging observations in focal pancreatitis.

The imaging findings that ultrasonographically differentiate focal acute pancreatitis (FAP) from a malignant lesion of the pancreas are described. Focal acute pancreatitis is ultrasonographically (US) characterized as a hypoechoic, homogeneous, localized, subsegmental, non-expansive and diffusely demarcated lesion located mostly in the head of the pancreas. It could not be visualized using CT. Endoscopic retrograde cholangiopancreatography (ERCP) performed in 13 of the 32 patients, showed chronic pancreatitis. Focal acute pancreatitis disappeared in 1-6 months at US follow-up. The clinical diagnoses were acute pancreatitis in 11 patients, chronic pancreatitis in 12 patients, biliary disease in 5 patients, hepatopathia in 1 patient while the diagnosis was unknown in 2 patients. No patient developed any pancreatic cancer during a median of 85 months of follow-up. In conclusion, the present data indicate that patients with FAP at US, without any focal lesion seen on either CT or ERCP, have a benign pancreatic lesion, which resolves in 1-6 months; thus, such patients probably do not need any further investigation or follow-up at all.

Acute Disease↗
PubMed1998

Survival following pancreatic carcinoma: a follow-up study of all cases recorded in Malmö, Sweden, 1977-1991.

BACKGROUND: The aim of this follow-up study was to assess whether there has been any increase in the percentage of patients offered attempted curative surgery for pancreatic carcinoma and whether the overall survival rate has improved, during the time period 1977-1991. METHODS: Details of new cases of pancreatic carcinoma arising in the population of Malmö during the study period were retrieved from the Local Tumour Register in Lund, Sweden. In all, 740 patients were found; 575 of these were diagnosed before death. Kaplan-Meier analysis was used to calculate overall survival rates, and Cox regression analysis was used to assess survival in relation to year of diagnosis after adjustment for sex, age at diagnosis and stage of disease. RESULTS: Cytological or histopathological evidence of the disease was given in 95 per cent of cases. The overall 5-year survival rate was 0.5 per cent (three of 575). Curative surgery was attempted in 24 patients (4.2 per cent); the proportion undergoing curative surgery increased in the last part of the study. Two of the 24 patients in this group survived for 5 years. CONCLUSION: The prognosis in pancreatic carcinoma remains dismal. Attempted curative surgery still is the only hope for cure, but the group of patients that can be offered this possibility is very limited. In this study, an increase was found in the proportion of patients who were offered attempted curative surgery, but there was no statistically significant increase in the 5-year survival rate following surgery.

Adenocarcinoma↗
PubMed1996

Extrapancreatic origin of the pancreatic secretory trypsin inhibitor as an acute-phase reactant.

The aim of the present investigation was to study the origin of the elevated levels of the pancreatic secretory trypsin inhibitor (PSTI) seen in the bloodstream during an acute-phase reaction. PSTI and cationic trypsinogen levels in pancreatic juice and plasma from five patients were measured over 8 days following subtotal pancreatoduodenectomy (Whipple's procedure). Cells from a human hepatocellular carcinoma cell line (Hep G2) and from a human pancreatic cancer cell line (CAPAN-1) were cocultured with endotoxin-stimulated mononuclear white blood cells using a double-chamber technique. Hep G2, CAPAN-1, and mononuclear white blood cells were also cultured as single populations. The median plasma level of PSTI increased from 16.6 micrograms/L at the time of surgery to 155 micrograms/L at the fourth postoperative day. No increase in PSTI levels in pancreatic juice or trypsinogen levels in pancreatic juice and plasma was observed. Culture medium from stimulated hepatocellular carcinoma cells contained significantly elevated levels of PSTI compared with the levels of PSTI from unstimulated cells. Culture medium from pancreatic cancer cells alone contained high levels of PSTI but no difference was observed compared with PSTI levels in medium from stimulated pancreatic cancer cells. The mononuclear white blood cells did not produce PSTI. The results support the view of an extrapancreatic origin of plasma PSTI during the acute-phase reaction and indicate that the liver is the probable source.

Acute-Phase Reaction↗
PubMed1994

High-dose intraperitoneal aprotinin treatment of acute severe pancreatitis: a double-blind randomized multi-center trial.

A multi-center double-blind trial was performed on 48 patients with severe acute pancreatitis. All patients were treated with intraperitoneal lavage. One group (n = 22) was also treated with high doses of the protease inhibitor, aprotinin (Trasylol; Bayer AG, Leverkusen, Germany) administered intraperitoneally. Eight patients died, giving a total mortality of 16.6%. No difference was observed between the two groups. Altogether, 12 patients were operated on, corresponding to 25%. In the group not treated with aprotinin, 6 patients were operated on because of pancreatic necrosis, compared with none in the treated group. The difference was statistically significant. There were no significant differences between the two groups with regard to organ failure or other complications. It was concluded that aprotinin counteracts the development of pancreatic necrosis when given intraperitoneally in high doses to patients with severe acute pancreatitis, thus reducing the need for surgical intervention in these patients.

Acute Disease↗
PubMed1994

Proteolytic activity in pancreatic pseudocyst fluid.

Pancreatic pseudocyst fluids from 15 patients were biochemically analyzed, especially concerning proteolytic activity and protease inhibitors, and correlated to the clinical course. The pseudocyst fluid was a mixture of pancreatic juice and plasma possessing a high proteolytic activity against high- as well against low-mol-wt proteins. There was practically no functional protease inhibitory capacity left, although immunoreactive inhibitors were present. No distinct biochemical findings differed between fluids from "acute" or from "chronic" pseudocysts. It is concluded, that high proteolytic activity within a pancreatic pseudocyst could well explain symptoms as well as complications caused by the pseudocyst. Biochemical analysis of the pseudocyst fluid cannot, however, be used to differentiate between pseudocysts with a harmless or a complicated course.

Acute Disease↗
PubMed1992

Pancreatico-duodenectomy: 13-years' experience.

This paper reports a retrospective study of 51 consecutive pancreatico-duodenectomies from a Swedish university hospital concerning postoperative morbidity, number of reoperations and mortality. Resection of the distal common bile duct, duodenum, and head of the pancreas with hemigastrectomy and cholecystectomy was done in 48 patients and modified pancreaticoduodenectomy with preservation of the pylorus was done in three patients. Three patients (6%) died within 30 days. Nine patients required reoperation, three more than once. The most common major complications were anastomotic breakdown (n = 7), severe hemorrhage (n = 3) and abscess formation (n = 3). We conclude that a low postoperative morbidity and mortality can be achieved outside large, specialist centres, but the operation should be done by experienced surgeons. The results may justify carrying out the operation when the chances of cure are small, but it has yet to be evaluated as a palliative procedure.

Adult↗
PubMed1989

Ultrasonography in the diagnosis of gallbladder carcinoma.

Sonographic examination of the gallbladder (GB) was performed in 21.646 patients. A histopathologically documented gallbladder carcinoma (GBC) was present in 59 patients (0.27%). Five different sonographic patterns were revealed with differences in number of associated findings, echo pattern and correct preoperative diagnosis. The sonographic diagnosis was correct in 59% and retrospective diagnosis in 65%. Most of the sonographically detectable GBC were inoperable (90%). 15 fine-needle biopsies were positive in 100% and reduced the number of explorative laparotomies. The survival rate was 3 days to 4 years after the first sonographic examination.

Adult↗
PubMed1988

Needle-tract seeding after percutaneous fine-needle biopsy of pancreatic carcinoma. Case report.

Needle-tract seeding is a rare complication following percutaneous fine-needle biopsy of intra-abdominal tumours and only a few cases have been reported. Two cases of cutaneous implantation of a tumour in the needle-tract after biopsy of pancreatic carcinomas are presented. In experimental studies, seeding of malignant cells in the needle-tracts is common and the discrepancy between experimental and clinical findings is discussed.

Adenocarcinoma↗
PubMed1986

Metabolism of 131I-labelled human pancreatic cationic trypsin after intraduodenal administration.

Human pancreatic cationic trypsin labelled with 131I was administered into the duodenum in 9 healthy individuals. Five had earlier been proctocolectomized and had ileostomies. Radioactivity was measured in plasma, urine, ileostomy content and feces for a period of 72 h. Radioactivity was present in plasma 15 min after administration. The total recovery of radioactivity was 78-98%, the largest amount being observed in urine during the first 24-hour period. About 20% of the administered radioactive dose was recovered in ileostomy content and 10% in feces. The recovered radioactivity in plasma, urine and extracts of ileostomy content and feces was characterized with dialysis and gel filtration. All radioactivity in plasma and urine corresponded to free 131I, whereas in the extracts radioactivity corresponding to intact enzyme and degradation products as well as a small amount of free 131I was observed. It is concluded that pancreatic trypsin is degraded during intestinal passage as with other proteins. Due to a deiodinating mechanism in the intestine, only free 131I is absorbed into the circulation. This deiodination does not take place in duodenal juice. The absence of high molecular weight radioactivity in plasma argues against an enteropancreatic circulation.

Adult↗
PubMed1986

Protease inhibitors in plasma and faecal extracts from patients with active inflammatory bowel disease.

The level and functional activity of the major protease inhibitors in plasma and faecal extracts were analysed in 26 consecutive patients admitted during their first attack of acute severe colitis. The patients were retrospectively divided into two groups: one with total colitis and another with distal colitis. The patients with total colitis had a significantly lower alpha 2-macroglobulin level in plasma than normal individuals and patients with distal disease, whereas no difference in the levels of alpha 1-protease inhibitor, antichymotrypsin, antithrombin III, and alpha 2-antiplasmin was noted between the two groups. The protease-inhibiting capacity was saturated, and free proteolytic activity was present in the faecal extracts. In the extracts complex formation was demonstrated between leukocyte proteases and the antiproteases alpha 1-protease inhibitor and alpha 2-macroglobulin. It is concluded that the low plasma level of alpha 2-macroglobulin in patients with severe total colitis is mainly due to a consumption caused by complex formation with proteases, as earlier demonstrated in patients with acute pancreatitis and sepsis.

Adult↗
PubMed1986

Characterization of radioactivity in plasma after intraduodenal administration of 131I-labelled human cationic trypsin.

Active human pancreatic cationic trypsin labelled with 131I was administered into the duodenum in nine healthy individuals pretreated with "cold", i.e. non-radioactive iodine. Radioactivity in plasma was measured during 72 hours and was present in plasma after 15 minutes with a maximum 1 hour after administration. The recovered radioactivity in plasma was characterized using dialysis and gel-filtration and the radioactive iodine was found to be in the form of free 131I. Our results are in agreement with recent experimental studies indicating the presence of de-iodinases in the intestine. Furthermore, it was found that pretreatment with "cold" iodine prevented isotope binding to circulating plasma proteins.

Adult↗
PubMed1985

Villous adenomas in the duodenum.

Five patients with villous adenomas in the duodenum are described. In one patient malignant degeneration had occurred at the time of diagnosis. This patient was treated with a pancreaticoduodenal resection and is doing well 2 years postoperatively. The other four patients all had a duodenotomy and a local excision of the tumour. One patient had a recurrence with malignant degeneration within 1 year. The other three patients are doing well without signs of recurrence 1-4 years postoperatively. It is concluded that duodenal villous adenomas are potentially malignant. The strategy of surgical treatment is discussed.

Adenocarcinoma↗
PubMed1985

Thrombosis in the superior mesenteric artery simulating acute pancreatitis. A case report.

A case of thrombosis in the superior mesenteric artery simulating acute pancreatitis, but causing intestinal gangrene, is described. The possibility of other simulating diseases must always be considered when non-operative peritoneal lavage is used as a treatment of acute pancreatitis. Bacteriological examination of the peritoneal fluid might be beneficial. Laparotomy is indicated when there is a marked discrepancy between the general condition of the patient and the objective clinical signs of pancreatitis.

Adult↗
PubMed1984

Fate of intravenously injected trypsin in dog with special reference to the existence of an enteropancreatic circulation.

In 3 mongrel dogs the pancreatic duct and bile duct were cannulated. After intravenous injection of 125I-labelled anionic dog trypsin bile, pancreatic juice and blood samples were collected during 3 h. 125I-trypsin is eliminated from the circulation in dogs with a half time of 15 min. Only 0.15% of the radioactivity is secreted in the pancreatic juice and 0.75% in the bile during 3 h. 10% of the radioactivity in pancreatic juice is protein bound and 45% in the bile is protein bound. The results argue against biologically significant enteropancreatic circulation of trypsin in dogs.

Animals↗