Biomedical subjects
U Hesse
Publications and source records attributed to U Hesse.
Role of somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data.
Somatostatin-14 and its analogue octreotide both exert inhibitory effects on gastrointestinal secretions and may therefore be beneficial in the treatment of gastrointestinal fistulae. There are no studies that have compared these two drugs directly and hence this paper aims to review studies that are available for each drug. There are only six controlled studies that have examined the effects of somatostatin-14 and octreotide on fistula output reduction, three for each drug. All studies compared conservative therapy and the drug in combination with conservative therapy. Of the somatostatin-14 studies, two showed a significant effect on output (p<0.05) and the other demonstrated an output reduction on day 1 that was twice that in the control group (NS). Of the octreotide studies, one showed a significant effect (p<0.01) and the other two showed no effect of the drug on output. No study with either drug has demonstrated an increase in the number of patients that have achieved closure. However, a positive effect on the time to achieve closure has been found. Of the five controlled studies with somatostatin-14, all showed a significant reduction in time to closure. Of the two controlled studies with octreotide, one showed a significant reduction (p=0.002) and the other showed no difference. Due to the limited number of trials, a definitive evaluation of the efficacies of somatostatin-14 and octreotide in the treatment of gastrointestinal fistulae is not possible. However, currently available information seems to suggest a considerable benefit of somatostatin-14 when administered in association with standard conservative treatment, but this needs to be confirmed in a large prospective controlled study.
The Swedish laparoscopic adjustable gastric banding for morbid obesity: radiologic findings in 218 patients.
OBJECTIVE: The objective of this study was to determine the prevalence and radiologic features of postoperative complications after Swedish laparoscopic adjustable gastric banding surgery and to emphasize the role of the radiologist in the follow-up of those patients, especially in the treatment of complications. MATERIALS AND METHODS: We reviewed the radiologic findings in 218 consecutive morbidly obese patients after laparoscopic placement of the Swedish gastric banding system. Radiographic studies of the stomach (obtained with liquid barium sulfate suspension) were performed before surgery and 1 month after band placement in every patient. Additional studies in symptomatic patients were performed when needed. RESULTS: Surgical complications found included misplacement of the band (five patients, 2.3%), slippage of the band (17 patients, 7.8%), and pouch enlargement (eight patients, 3.7%). Technical problems encountered were inversion of the access port (three patients, 1.4%), leakage of the device (two patients, 0.9%), and spontaneous decrease of the stoma size caused by gastritis (seven patients, 3.2%) or the hyperosmolar properties of the IV contrast material (12 patients, 5.5%). Intrinsic abnormalities of gastroesophageal tract seen included trapping of food in the stoma (four patients, 1.8%) and esophagitis (11 patients, 5%). CONCLUSION: Although, according to the available data, the gastric banding operation with the Swedish band meets the criteria of a low-risk laparoscopic alternative treatment of morbid obesity, the radiologic appearances of various complications may be seen on the images of patients who have undergone the procedure. The radiologist plays a key role in the early detection of those complications and treatment of specific abnormalities.
Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994.
OBJECTIVE: The objectives were first to analyse differences in long-standing illness, limiting long-standing illness, and perceived health as below good in relation to different indicators of social class over time; and secondly to analyse the association of long-standing illness, educational level, age, and gender with employment status. SUBJECTS AND METHODS: Self-reported information on illness, educational level, employment status, and occupational class was obtained in two nationally representative Danish health interview surveys in 1987 (n=4753) and 1994 (n=4668). RESULTS: There was a marked increase in long-standing illness from 1987 (33%) to 1994 (38%), especially among women with higher education (13% in 1987 to 26% in 1994). The prevalence of perceived health below good was unchanged (c. 20%) during the same period. Among employed men in 1987 the lowest prevalence of long-standing illness was seen in upper salaried employees (21%) and the highest in skilled workers (35%). In 1994, the difference had diminished and the prevalence rates for the same classes were 28% and 29%, respectively. Among employed women, a similar pattern was seen. The lowest rate in 1987 was seen among self-employed with subordinates (15%) and the highest in self-employed without subordinates (28%). In 1994, the difference was reduced with prevalence rates of 23% and 32%, respectively. In addition, substantial differences in health status between groups with different educational backgrounds were found. The proportion of the population with long-standing illnesses was clearly higher in the group with low education compared with the group with high education. A similar social gradient was found for perceived health as below good. Those with the highest odds ratio of being a disability pensioner are women with long-standing illness, only basic education, and above 55 years of age. CONCLUSION: In conclusion, the study showed that the prevalence of long-standing illness increased from the mid-1980s to the mid-1990s, whereas perceived health below good was unchanged. In 1994, there was a remarkable difference in health between employed and non-employed people, indicating a health-related exclusion from the labour market. This may explain why, in 1994, smaller occupational class differences were found in the prevalence of long-standing illness among employed people compared with the findings in 1987, whereas the health differences remained in the different educational groups. Women above 54 years of age with basic education only and long-standing illness have the highest odds ratio of permanent exclusion from the labour market.
Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intra-abdominal cancer.
BACKGROUND: Surgical treatment of intra-abdominal cancer is often followed by local recurrence. In a subgroup of patients, local recurrence is the sole site of disease, reflecting biologically low-grade malignancy. These patients might, therefore, benefit from local treatment. Recently, debulking surgery followed by hyperthermic chemoperfusion has been proposed in the treatment of locally advanced or recurrent intra-abdominal cancer. This paper reviews the rationale and assesses the currently accepted indications for and results of this novel treatment. METHODS: A systematic web-based literature review was performed. Information was also retrieved from handbooks, congress abstracts and ongoing clinical trials. RESULTS: A growing body of experimental evidence supports the use of hyperthermia combined with chemotherapy as an adjunct to cytoreductive surgery. Randomized clinical trials are available to support its use in the treatment and prevention of peritoneal carcinomatosis following resection of pathological tumour stage pT3 or pT4 gastric cancer; several other phase III trials are ongoing. Numerous phase I and II trials have reported good results for various other indications, with acceptable morbidity and mortality rates. Case mix, limited patient numbers and absence of a standardized technique are, however, a drawback in many of these series. CONCLUSION: For a subgroup of patients with peritoneal cancer without distant disease, debulking surgery followed by hyperthermic chemoperfusion may offer a chance of cure or palliation in this otherwise untreatable condition. This novel therapy should, however, be considered experimental until further results from ongoing phase III trials become available.
Giant intraluminal duodenal diverticulum: conventional barium study and computed tomography findings.
A case is reported of an asymptomatic intraluminal duodenal diverticulum (IDD) in a 21-year-old male patient with associated congenital abnormalities. During endoscopy for anemia an ostium in the duodenum was visualized, presumed to be the entry to an extraduodenal diverticulum. Upper gastrointestinal (UGI) barium examination showed, however, findings compatible with IDD. This diagnosis was supported by an abdominal computed tomographic (CT) examination. Surgical resection revealed a web in D2 with coexistent large IDD.
Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis.
In a case-control study performed in two centers, the incidence of delayed graft function (DGF), defined as the necessity to perform dialysis after transplantation, was analyzed according to prior treatment with continuous ambulatory peritoneal dialysis (CAPD; n = 117) or hemodialysis (HD; n = 117). The patients were matched for age, sex, HLA compatibility, and cold ischemia time. The patients were followed up for 6 months to monitor renal graft function (serum creatinine [Screa] level immediately after transplantation, at 6 weeks, at 6 months) and postoperative complications. No significant differences were found in the warm ischemia time of the graft or previous time on dialysis. DGF occurred in 27 CAPD patients (23.1%) and 59 HD patients (50.4%; P < 0.0001). The decline in Screa level after transplantation was faster in CAPD patients: the time for Screa level to decrease 50% after transplantation (T1/2Screa) was reached after 5.0 +/- 6.6 days in the CAPD group compared with 9.8 +/- 11.5 days in the HD group (P < 0.0001). A greater number of patients developed acute rejection episodes in the CAPD group (P < 0. 05), but Screa level was not different in the two groups 6 weeks and 6 months after transplantation. No differences were observed in infectious or surgical complications. This study shows that immediate renal function after transplantation is better in CAPD patients and that peritoneal dialysis should be considered as a first choice for pretransplantation therapeutic modality.
Use of 1-methyl-pyrrolidone as a solubilizing agent for determining the uptake of poorly soluble drugs.
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Use of a unilateral pudendal thigh flap in the treatment of complex rectovaginal fistula.
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Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding.
BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch. SURGICAL TECHNIQUE: A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described. CONCLUSION: A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.
Successful sequential orthotopic liver transplantation in the treatment of familial amyloidotic polyneuropathy.
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Histological assessment of combined chemoembolization and alcoholization [corrected] for hepatocellular carcinoma in cirrhotic patients.
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The impact of donor age on graft outcome after liver transplantation.
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Initial experience with the use of preoperative transarterial chemoembolization in the treatment of liver metastasis.
We retrospectively evaluated the influence of preoperative Transarterial Chemoembolization (TAE) on technique and complications, tumour histology, and disease-free survival after surgery for hepatic metastasis. In a 2-year period, a total of 23 patients were treated. In a first group of 14 patients, preoperative TAE was performed; in a second group of 9 patients only surgical resection was done. Extensive tumour necrosis was seen in the majority of patients treated with TAE; in tumours with an important fibrotic component, embolization was less effective. No significant effect was seen on operating time, transfusion requirement or perioperative complication rate. In the group of patients who underwent TAE, survival rate was 93% after a mean follow-up period of 15.5 months (SD: 12.5); recurrence was seen in only 8% of the survivors. In the second group, however, mortality was 33% after a median follow-up of 17.5 months (SD: 10), and recurrence was present in 66.7% of the survivors. These results indicate that preoperative TAE reduces the recurrence rate in the first postoperative year. Thereby survival may be improved in patients with resectable metastatic liver cancer.
Early postoperative renal dysfunction after adult liver transplantation.
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Combined use of fluconazole and selective digestive decontamination in the prevention of fungal infection after adult liver transplantation.
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Small bowel perforation following blunt abdominal trauma.
Small bowel perforation is a relative infrequent complication of blunt abdominal trauma. We reviewed the literature regarding this clinical entity and describe our experience in 22 patients. There were 17 male and 5 female patients; mean age was 34 years. Cause of the trauma was road traffic accident (18 cases) or fall (4 patients). Clinical investigation, peritoneal lavage, CT scanning, upper GI tract opacification and subsequent laparotomy revealed a lesion of the duodenum in 3 cases, of the jejunum in 15 cases and of the ileum in 4 cases. Therapy consisted in primary closure of the bowel (17 cases); tube drainage in 4 cases and anus praeter in 1 case. One patient died because of ARDS and inflammatory syndrome; all the other patients had an uneventful postoperative course. It is concluded that peritoneal lavage remains the most appropriate diagnostic approach. In the absence of peritonitis primary closure can be safely done; otherwise tube drainage or anus praeter construction should be performed.
HDL3-mediated cholesterol efflux from cultured enterocytes: the role of apoproteins A-I and A-II.
High density lipoproteins (HDL) were recently demonstrated in an enterocyte model (CaCo-2 cells) to mediate reverse cholesterol transport by retroendocytosis. The present study was carried out to define the role of the major HDL apoproteins (apo) A-I and apo A-II in this pathway. HDL3 was fractionated by heparin affinity chromatography into the two main fractions containing either apo A-I only (fraction A) or both apo A-I and apo A-II (fraction B). In addition, liposomes were reconstituted from purified apo A-I or apo A-II and dimyristoyl phosphatidylcholine. The cell binding properties and cholesterol efflux potential were studied in the lipoprotein fractions and the liposomes. Both fractions exhibited similar maximal binding capacities of 4427 (A) and 5041 (B) ng/mg cell protein, but their dissociation constants differed (40.5 and 167.7 micrograms/mL, respectively). Fraction A induced cholesterol efflux and stimulated cholesterol synthesis more than did fraction B. Fraction A mobilized both cellular free and esterified cholesterol, whereas fraction B preferentially mobilized cholesteryl esters. Liposomes, containing either apo A-I or apo A-II, showed specific binding, endocytosis and endosomal transport, and were released as intact particles. Apo A-I liposomes also mediated cholesterol efflux. In conclusion, there is evidence that the HDL3 subfractions A and B, as well as reconstituted liposomes containing either apo A-I or apo A-II, were specifically bound and entered a retroendocytosis pathway which was directly linked to cholesterol efflux. Quantitatively, the apo A-I subfraction appeared to play the dominant role in normal enterocytes. The apo A-II content of fraction B was related to the mobilization of cholesteryl esters.