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Biomedical subjects

T Kalima

Publications and source records attributed to T Kalima.

At least 19 recordsLinked to original sources
PubMed1991

Comparison of endoscopic Nd:YAG laser therapy and oesophageal tube in palliation of oesophagogastric malignancy.

The clinical results of 96 patients with upper gastrointestinal malignancy have been evaluated retrospectively. Sixty-nine patients with a mean age of 72 years (35 men and 34 women) were treated with endoscopic laser therapy, and 27 patients with a mean age of 67 years (16 men and 11 women) with insertion of an oesophageal tube. After laser therapy the bulk of the tumour was reduced in 87%, and in 55% clear signs of relieved dysphagia were seen. The insertion of an oesophageal tube was successful in 89%. In the laser group no fatal complications occurred, and the overall complication risk was 8.7%. The 1-year survival in all laser patients was 12%, and in patients with impassable tumour stenosis the survival was 6%. The mortality related to the insertion of an oesophageal tube was 11%, and complications occurred in 48% of the patients. The 1-year survival of the tube group was nil. It is concluded that endoscopic laser therapy and insertion of oesophageal tube are both effective methods in palliation of oesophagogastric malignancy, but the mortality and risk for complications were markedly lower after laser therapy.

Adenocarcinoma↗
PubMed1990

Decreased risk of gastric stump carcinoma after partial gastrectomy supplemented with bile diversion.

The exact incidence of gastric stump cancer is not known. The reported incidence figures vary greatly, even in studies using similar methods. The aim of this study was to re-evaluate the risk of gastric stump cancer after gastric surgery for peptic ulcer in the Finnish population. A total of 285 patients (252 men and 33 women) operated on for benign peptic ulcer between 1948 and 1954 were followed-up till the end of 1984 (mean for men = 19.4 years, for women = 22.9 years). At the end of 1984 58 patients (20%) were still alive with no verified gastric cancer. One patient developed gastric cancer within five years after the operation and was excluded from the series. Nine patients (3%) were lost to follow-up. Six patients (four men and two women) of the total 285 had developed gastric cancer 6, 7, 8, 21, 25 and 27 years after operation. The risk of getting gastric cancer in a control population (no operation) of equal size and age during a similar follow-up period was 6.71 cases for men and 0.86 cases for women (total = 7.57). The observed number (6 patients) does not differ significantly (P greater than 0.5) from the expected number (7.57). According to this study the risk of gastric cancer is not significantly increased by partial gastrectomy for benign peptic ulcer.

Adult↗
PubMed1990

Decreased risk of gastric stump carcinoma after partial gastrectomy supplemented with bile diversion.

The exact incidence of gastric stump cancer is not known. The reported incidence varies greatly, even in studies using similar methods. The aim of this study was to re-evaluate the risk of gastric stump cancer after gastric surgery for peptic ulcer in the Finnish population. A total of 285 patients (252 men and 33 women) operated on for benign peptic ulcer between 1948 and 1954 were followed-up till the end of 1984 (mean follow-up for men = 19.4 years, for women = 22.9 years). At the end of 1984, 58 patients (20%) were still alive without verified gastric cancer. One patient developed gastric cancer within five years after the operation and was excluded from the series. Nine patients (3%) were lost to follow-up. Six patients (four men and two women) of the total 285 developed gastric cancer 6, 7, 8, 21, 25 and 27 years after the operation. The risk of contracting gastric cancer in a control population (no operation) of equal size and age during a similar follow-up period was 6.71 cases for men and 0.86 cases for women (total = 7.57). The observed number (6 patients) does not differ significantly (P less than 0.5) from the expected number (7.57). This study shows that the risk of gastric cancer does not significantly increase after partial gastrectomy for benign peptic ulcer.

Female↗
PubMed1989

Treatment of pancreatic fistulas with somatostatin and total parenteral nutrition.

Nineteen pancreatic fistulas were treated with somatostatin (ST) and total parenteral nutrition (TPN). Five of the fistulas developed in an uninflamed pancreas, whereas 14 fistulas developed secondary to a necrotizing or chronic pancreatitis. Fistular output varied between 20 and 800 ml/day (median, 160 ml) during TPN before ST treatment; amylase concentration was 10,500-800,000 UI/l. Twelve of 16 (75%) fistulas were contaminated with bacteria. Thirteen of 19 (68%) fistulas closed after a median treatment of 7 (range, 2-14) days. Seven of eight fistulas with open drainage to the bowel healed, whereas only one of six with obstructed drainage closed. All of the uninfected fistulas and half of the infected fistulas closed. The findings suggest that somatostatin treatment speeds up the closure of pancreatic fistulas with open drainage to the bowel but is not beneficial when the intestinal drainage of the fistular region to the bowel is obstructed.

Adult↗
PubMed1989

Endoscopic Nd:YAG laser therapy in upper gastrointestinal bleeding.

Between 1983 and 1986 thirty-seven patients with upper gastrointestinal bleeding or stigmata of acute bleeding were treated at the Second Department of Surgery with endoscopic laser therapy. The non-contact method was used. The cause of bleeding was gastric ulcer in 13 cases and duodenal ulcer in 5. Two patients had anastomotic ulcer, 6 had a simple ulcer, 7 had telangiectases (Mb. Osler), 2 had Mallory Weiss tears and 2 bled after gastric biopsy. Twenty-one patients bled during endoscopy and 16 had signs of recent bleeding. During acute bleeding laser treatment was effective in 95% (1, 3). However, 41% of all patients (15/37) rebled within a week after laser therapy and in 30% (11/37) an emergency operation was necessary. The overall mortality rate was 10.8% (4/37). Endoscopic laser coagulation is successful in the initial treatment of acute upper GI-bleeding. However, there is a considerable risk of rebleeding. Acute laser therapy may change an emergency operation into an elective one, provided that the group at risk of rebleeding can be anticipated at first endoscopy.

Duodenal Ulcer↗
PubMed1988

Duodenal atresia: late follow-up.

In this study, 41 randomly chosen patients aged 15 to 35 years (mean 22 years) were carefully examined. As primary operations there were 13 membrane excisions, five duodenoduodenostomies, 22 duodenojejunostomies, and one gastrojejunostomy. Twenty-eight patients were symptom-free, ten admitted some discomfort, three had major pains, including one with a history of duodenal ulcer. Reoperation for adhesion ileus had been performed in six patients, in the early postoperative phase in one instance. At late follow-up barium meals (N = 41) showed completely normal findings in two cases only, hiatal hernia in two, gastritis in three, duodenogastric reflux in 12, slight dilation of the duodenum with good emptying and no reflux in 16, a huge duodenal sac in nine, diminished peristalsis in eight, delayed emptying in five, slight luminal narrowing in three, duodenal diverticuli in nine, bezoars in two, and a polyp in the duodenum of one patient. Ultrasound (N = 35) revealed a gallbladder septum in one patient and a dilated common bile duct in another; in one subject the gallbladder was not visualized satisfactorily. Isotope biligraphy (N = 15) showed biliary reflux to the stomach in 12 cases. Endoscopy (N = 20) findings were: esophagitis (1), hiatal hernia (2), gastric mucosa in the lower esophagus (2), biliary reflux (9), gastritis (7), gastric polyps (2), dilated duodenum of variable degree (19), diminished peristalsis (4), marked retention (2), abnormal papilla (3), diverticuli (4), and a persistent membrane (1). Histology showed superficial gastritis in three patients. E coli was cultured from the duodenal juice in five patients and Candida found in two.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Fibre-endoscopic dilatation of peptic oesophageal strictures.

51 patients with dysphagia caused by peptic oesophageal stricture due to primary or secondary reflux oesophagitis were treated by fibre-endoscope and Eder-Puestow dilatations under local anaesthesia and sedation, between 1976 and 1984. There was one death (2%) attributable to the procedure (perforation) and complications arose in three (6%) patients (perforation, pneumonia). The dilatation was successful in 96% but two patients (4%) had to be operated on because of undilatable stricture. Follow-up data was available for the other 44 patients for periods of one to eight (mean 2.8) years later. The stricture was cured by dilatation and antireflux treatment (conservative or operative) in all patients and 98% of them were able to eat solid food and improve their nutritional status. During follow-up 22 patients (50%) were asymptomatic and 22 (50%) had dysphagia or/and reflux symptoms. At endoscopy oesophagitis was healed with conservative or operative treatment in 25 patients (57%). It is concluded that fibre-endoscopic dilatation of peptic oesophageal strictures with the Eder-Puestow system combined with conservative or operative antireflux treatment, is a simple and safe procedure and gives good results in almost all patients. Surgical procedures aimed at total correction of the stricture are indicated only rarely in intractable cases.

Adult↗
PubMed1987

Local management in primary breast cancer. Our experience of 331 cases.

The peroperative exploration of axillary content gave wrong result from the stage of axillary nodes in every fourth case compared with the final result of axillary evacuation. There were no locoregional recurrences in stage I-patients irradiated after mastectomy. In postoperatively irradiated stage II-patients there were locoregional recurrences in 2.5% of cases, which was 1/8 of recurrences of patients not irradiated postoperatively.

Adult↗
PubMed1986

Postoperative active specific immunotherapy with supportive measures in patients suffering from recurrent metastasized melanoma: case reports of six patients.

The clinical results from postoperative active specific immunotherapy using autologous polymerized tumor material in six patients suffering from metastasized melanoma is reported. Correction of an alleged systemic deficiency leading to malignant cell transformation was attempted by administering certain essential trace elements, amino acids, vitamins, and a diet containing lipids, extracted from the mammalian central nervous system, after heating. Vaccinations against influenza were also given as a precaution against certain viral infections sometimes seen to precede melanoma recurrence. The clinical results with this postoperative adjuvant therapy are so encouraging that we suggest that sterile tumor tissue should be saved at operation and treated to produce insoluble particles as an option for postoperative treatment of patients suffering from metastasized melanoma. Prospective randomized studies are indicated.

Adult↗
PubMed1985

Active specific immunotherapy with supportive measures in the treatment of palliatively nephrectomized, renal adenocarcinoma patients. A thirteen-year follow-up study.

The results of a 13-year (1971-1984) follow-up of specific active immunotherapy using polymerized autologous tumor tissue with adjuvants and supportive measures, following palliative nephrectomy in 71 patients suffering from advanced renal adenocarcinoma, are presented. The control patient group comprised 56 patients who received the best possible conservative treatment available. The statistically calculated life expectancy in the immunotherapy group is 44.5 months (SE 5.7) and in the control group 19.0 months (SE 3.3). The difference is statistically highly significant (generalized Wilcoxon [Breslow], t = 14.9, p less than 0.0001). There were no serious side effects from the immunization. The supportive measures entailing the administration of factors involved in cell regulatory functions mediated by the central nervous system, amino acids, trace elements, hormones and vitamins has still to be optimized.

Adjuvants, Immunologic↗
PubMed1982

Bile acid composition and esophagitis after total gastrectomy.

Ten patients who had undergone total or subtotal gastrectomy for carcinoma 1 to 8 years earlier were evaluated in terms of subjective symptoms, endoscopy and the presence of bile in esophagojejunal aspirates obtained by direct aspiration during endoscopy. The concentrations of individual bile acids were determined by means of gas chromatography. Six of the patients had macroscopic esophagitis and all of them also had bile in their aspirate. The remaining four patients with normal esophageal mucosa did not have positive specimens. Neither did the total bile acid concentration nor any of the individual bile acids, regardless of whether they were free or conjugated, correlate with the severity of symptoms or the degree of endoscopic esophagitis. Esophagitis healed in all three patients who underwent conversion of loop esophagojejunostomy to a long Roux-Y reconstruction.

Adult↗
PubMed1982

Gastric blood flow, tissue gas tension and microvascular changes during hemorrhage-induced stress ulceration in the pig.

Various features of blood supply to the gastric mucosa were studied in the piglet stomach during stress ulceration induced by hemorrhagic shock. Gastric blood flow, as measured by the radioactive microsphere technique, significantly decreased during shock, but no major change occurred in the gastric function of total cardiac output. There was no difference in the magnitude of the decrease of mucosal blood flow between the nonulcerating antral mucosa and the more readily ulcerating corpus or fundic mucosa. At the same time, a significant decrease in tissue partial pressure of oxygen and increase in tissue partial pressure of carbon dioxide occurred, but again no difference was observed between the antrum and the corpus. Microangiographic studies demonstrated a clearly diminished filling of the arterial and capillary bed of the gastric mucosa during shock, suggesting intense vasoconstriction, thrombosis of the mucosal blood vessels, or both. These changes were more prominent in the corpus portion of the stomach than in the antrum. At the site of mucosal lesions, the filling defects persisted even after the shock, suggesting permanent thrombosis of the blood vessels.

Angiography↗
PubMed1982

Decreased prevalence of gallstones in gastric cancer.

The prevalence of gallstones and the frequency of previously performed cholecystectomy were examined in 498 autopsy subjects who had gastric cancer and their age- and sex-matched control subjects. The frequency of gallstones not treated by operation and previous cholecystectomy was significantly (p less than 0.01) lower in those with gastric cancer than in the matched-control subjects. It is not possible to determine on the basis of this study what the possible factors that cause this phenomenon are.

Adult↗
PubMed1982

Combined trabeculectomy and cataract operation. A follow-up study.

In a study of 94 combined cataract and trabeculectomy operations performed for 59 open angle simplex and 35 capsular glaucoma with coexisting cataract, followed up for 1 to 9 years, the overall control of intraocular pressure (less than or equal to 21 mm Hg) without therapy was achieved in 61 eyes (65%). The average follow-up time was 3.4 years. The success rate 76% after 1 year follow-up decreased to 63% after 2 years and went from 45 to 66% over a 3 to 8 years follow-up period. Post-surgical therapy was required in 33 eyes (35%). Of these 31 eyes were controlled with medical therapy alone. In the light of the results the maintenance of filtration was considered the most important factor of success. Most frequent complications, transient hypotony (37%) and hyphaema (30%) had no significant effect on eventual success. As regards the diagnostic categories no significant difference existed in the success rates between the simplex and capsular glaucoma groups. The importance of periodic observation is discussed.

Aged↗
PubMed1981

Bile reflux after cholecystectomy.

Regurgitation of duodenal juice into the stomach is generally accepted to have a damaging effect on gastric mucosa. It may cause endoscopically visible irritation and microscopically detected superficial inflammation. Some years after cholecystectomy this reflux disease of the gastric mucosa is significantly more frequently observed than in persons who have normally concentrating gall bladder. The possible role of a gall bladder as bile reservoir is discussed concerning the pathogenesis of reflux gastritis.

Bile Reflux↗
PubMed1981

The detection of duodenogastric reflux with a non-invasive method using cholescintigraphy.

A non-invasive method to detect duodenogastric reflux is presented. The distribution of a hepatobiliary tracer 99mTc-diethyl-IDA is recorded after an intravenous injection of the substance for one hour. Normally the tracer is excreted through the liver into the biliary tract and into the duodenum, and the further passage proceeds it aborally in the intestine. In duodenogastric reflux, the radioactive tracer enters the stomach where it can be recorded with a gamma camera as a sign of the reflux. The identification of the intragastric tracer is sometimes difficult. A computerized recording with high frequency of frames and rotations of the patient aid in the detection of duodenogastric reflux. A computerized recording also gives a possibility for semiquantitative estimation of regurgitated duodenal fluid. The observed frequencies of duodenogastric reflux were 10 and 13.5 per cent in the two patient groups that were studied.

Bile Reflux↗
PubMed1980

Reduction of the risk of acid pulmonary aspiration in anaesthetized patients after cimetidine premedication.

Forty-two patients undergoing elective general surgery received either placebo, cimetidine 300 mg, or cimetidine 600 mg orally 1.5-2 h before anaesthesia in a double-blind, randomized study. Another 13 subjects received no oral premedication and served as a control group. When compared to placebo or control patients, both doses of cimetidine significantly (P less than 0.01) decreased the acidity and volume of gastric contents. None of the subjects given cimetidine were in the risk range of acid pulmonary aspiration (pH under 2.5 plus volume over 25 ml), whereas 46% of the control patients and 40% of the patients given placebo (P less than 0.005 vs cimetidine in both groups) were in the risk range.

Administration, Oral↗