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Biomedical subjects

T Halvorsen

Publications and source records attributed to T Halvorsen.

27 records · Page 2Linked to original sources
PubMed1986

The clinical benefit of routine upper gastrointestinal endoscopy.

In a prospective study including 1526 consecutive endoscopies, attempts were made to characterize the benefit of upper gastrointestinal endoscopy. Before endoscopy judgements were made about the most likely diagnosis and treatment and about the degree of suspicion of upper gastrointestinal malignancy. After endoscopy the same types of judgement were made again. The study showed that about half of the endoscopies disclosed clinically significant abnormalities. Furthermore, about every third endoscopy led to unpredicted diagnostic and diagnostic and therapeutic consequences. The benefit was comparably small in patients below the age of 40 years and particularly great in patients above the age of 65, in patients submitted to endoscopy because of barium meal pathology or general suspicion of malignancy, and in patients with upper gastrointestinal bleeding. In general, the present study supports the widespread use of upper gastrointestinal endoscopy in clinical practice.

Adolescent↗
PubMed1986

Hiatus hernia in gastroesophageal reflux disease.

Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often (p less than 0.05) in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests (p less than 0.02). Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 of 50 versus 28 of 51; p less than 0.01), gastroesophageal scintigraphy (47 of 50 versus 40 of 51; p less than 0.05), and radiography (20 of 50 versus 2 of 51; p less than 0.001) than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH.

Barium Sulfate↗
PubMed1986

The acid perfusion test in gastroesophageal reflux disease.

An acid perfusion test, isotope scanning, endoscopy, and esophageal biopsy were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. A positive acid perfusion test within 30 min (APT) and within 5 min (TAPT) was found in 70.2% and 37.6% of the patients, respectively. A positive APT was found significantly more often in patients with than without endoscopic esophagitis, whereas a positive TAPT was found significantly more often in patients with severe symptoms than in patients with moderate symptoms and in a significantly higher proportion of patients with than without GER by scintigraphy. Neither the APT nor the TAPT showed any dependency on the presence of histologic esophagitis. Most (97%) patients with a negative acid perfusion test, in addition to typical symptoms, also presented with scintigraphic, endoscopic, or histologic evidence of GER disease. Although it shows that the acid perfusion test, particularly when early positive, may serve as a weak predictor of the severity of GER disease, the present study gives little support to the test's clinical usefulness.

Adult↗
PubMed1986

Gastroesophageal reflux disease. Scintigraphic, endoscopic, and histologic considerations.

Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes and in 43.7% patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently (p less than 0.05) in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis (p = 0.07). Fifteen of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation.

Adult↗
PubMed1986

Gastroesophageal reflux disease. Acute and maintenance treatments with cimetidine.

The comparative efficacy of a 12-week acute treatment with 800 and 1600 mg cimetidine daily and the effectiveness of a 400-mg single-dose maintenance treatment versus placebo lasting 6 months were studied in a double-blind fashion in 30 and 24 patients, respectively, with gastroesophageal reflux (GER) disease. Cimetidine in a dose of 800 or 1600 mg daily resulted in a significant symptomatic improvement and a decrease in the extent of endoscopic esophagitis. An improvement in the gastroesophageal sphincter function during treatment was suggested by a significant decrease in the frequency of reflux, as evaluated by isotope scintigraphy. No significant differences were found between the two doses of cimetidine. The overall initial improvement tended to be maintained during maintenance treatment, but no significant differences were found between cimetidine and placebo. The present study thus supports the use of 800 mg of cimetidine daily for short-term treatment of GER disease but provides no support for maintenance treatment with a low dose. The study further suggests that cimetidine treatment, by reducing the tendency to GER, may induce long-lasting remission of the disease.

Adult↗
PubMed1985

Intimal hyperplasia and secondary changes in vein grafts.

Intimal hyperplasia is of greatest prognostic importance for autologous vein grafts. The mechanism of this process is largely unknown, although a combination of traumatic, hemodynamic and metabolic factors are probably involved. In addition, secondary atherosclerosis may be responsible for diffuse graft obstruction. Fibrotic valves, traumatic stenosis and suture stenosis, probably due to improper handling during harvesting of the saphenous vein, give rise to segmental narrowing of the grafts. Changes in flow characteristics in addition to compliance mismatch may be responsible for the occurrence of anastomotic hyperplasia seen following implantation of synthetic vascular grafts and vein grafts. The prophylaxis and treatment of these conditions is discussed.

Endothelium↗
PubMed1975

The measurement of drug consumption. Drugs for diabetes in Northern Ireland, Norway and Sweden.

The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. ""Agreed daily doses'' were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of ""agreed daily doses'' per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April-June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.

Diabetes Mellitus↗