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Biomedical subjects

A Bakka

Publications and source records attributed to A Bakka.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Administrative handling of gastrointestinal hemorrhage in Norway].

Rapid and adequate endoscopic treatment is a vital part of the initial handling of gastrointestinal haemorrhage. A national survey was carried out to study the logistics of the initial handling of these patients. Replies were received from 97% of the hospitals, each of which received an average of 11 patients per month with haematemesis/melena or rectal bleeding. Patients with haematemesis or melena were admitted primarily to medical departments or intensive care units, while patients with haematochezia were admitted most often to the surgical department. 47% of the hospitals performed emergency endoscopy as a routine on patients with red haematemesis, but even in this group of patients, endoscopy was postponed until the first working day in some instances, provided that the patient's condition was stable. The majority of emergency flexible endoscopies are performed by internists, but most hospitals describe close inter-departmental cooperation in the handling of these patients. The situation was deemed satisfactory at 91% of the hospitals.

Emergency Service, Hospital↗
PubMed1996

Ex vivo ras peptide vaccination in patients with advanced pancreatic cancer: results of a phase I/II study.

In a pilot I/II study we have tested synthetic ras peptides used as a cancer vaccine in 5 patients with advanced pancreatic carcinoma. The treatment principle used was based on loading professional antigen-presenting cells (APCs) from peripheral blood with a synthetic ras peptide corresponding to the ras mutation found in tumour tissue from the patient. Peptide loading was performed ex vivo and the next day APCs were re-injected into the patients after washing to remove unbound peptide. Patients were vaccinated in the first and second week and thereafter every 4-6 weeks. In 2 of the 5 patients treated, an immune response against the immunising ras peptide could be induced. None of the patients showed evidence of a T-cell response against any of the ras peptides before vaccination. The treatment was well tolerated and could be repeated multiple times in the same patient. Side effects were not observed even if an immunological response against the ras peptide was evident. We conclude that ras peptide vaccination according to the present protocol is safe and may result in a potentially beneficial immune response even in patients with advanced malignant disease.

Adult↗
PubMed1996

[Free vascular grafts in reconstructions in the head and neck region].

Since 1989, 40 free-tissue grafts were used in 39 patients to repair defects following major head and neck ablative surgery (n = 32) and for reconstruction of the mandible because of osteoradionecrosis or trauma (n = 7). The radial forearm flap was used in 17 patients (five including a segment of radius), the lateral arm flap in seven, fibula in five and a segment of ileum for restoration of the hypopharynx in 11 cases. Three radial forearm flaps and the bone in one lateral arm flap failed. Better functional and cosmetic results seem to be obtained with free flaps than with other reconstructive techniques.

Craniocerebral Trauma↗
PubMed1995

Vaccination with mutant ras peptides and induction of T-cell responsiveness in pancreatic carcinoma patients carrying the corresponding RAS mutation.

Mutations in codon 12 of K-RAS are frequently found in pancreatic adenocarcinomas. T-cell responses specific for individual RAS mutations can be elicited in vitro by stimulation of peripheral blood mononuclear cells with synthetic peptides. Mutant ras peptides are therefore a candidate vaccine for specific immunotherapy in pancreatic carcinoma patients. When vaccinated with a synthetic ras peptide representing the K-RAS mutation in their tumours, a transient ras-specific T-cell response was induced in two of five patients treated. The vaccination protocol involved multiple infusions of large amounts of peptide-pulsed antigen-presenting-cells obtained by leucapheresis. These results indicate that specific T-cell responses against mutations uniquely harboured in tumour cells can be induced in cancer patients by vaccination.

Adenocarcinoma↗
PubMed1995

[Severe mucormycosis after organ transplantation. Report of a case].

Opportunistic infections remain one of the penalties of the immunosuppression required for successful outcome of organ transplantation. We report the case of a 51 year old woman who, after having received combined kidney and pancreas transplants, developed invasive mucormycosis in the gastrointestinal tract. The hallmarks of successful management of this rare but potentially fatal fungal infection are radical surgical debridement, aggressive antimycotic therapy and control of any underlying diseases. Diagnostic and therapeutic approaches are discussed.

Antifungal Agents↗
PubMed1995

Respiratory burst of intestinal macrophages in inflammatory bowel disease is mainly caused by CD14+L1+ monocyte derived cells.

Macrophages play a crucial role in intestinal mucosal defence, forming dense subepithelial aggregates, particularly in the colon. One of their important bactericidal mechanisms is production of oxygen radicals but this may damage the intestinal epithelium, perhaps as an early step in inflammatory bowel disease (IBD). The potential for release of oxygen radicals from mucosal macrophages in IBD was measured and whether a difference exists between newly arrived (CD14+L1+) monocyte-like cells and resident macrophages (CD14(-)L1-), without or with additional priming in vitro, was investigated. Lamina propria mononuclear cells from six patients with IBD and five with a normal intestine were isolated with an ethylenediaminetetra acetic acid/collagenase/dispase technique and cultured for three days. The cells were tested with or without interferon gamma (200 U/ml) priming in the presence or absence of lipopolysaccharide (1 microgram/ml) for the last 48 hours in cultures. Samples from inflamed IBD mucosa depleted of CD14+ cells by immunomagnetic beads were compared with their undepleted counterparts and with samples from virtually normal mucosa from the same patients. The production of oxygen radicals was measured as the amount of reduced cytochrome C 2.5 hours after triggering with phorbol 12-myristate 13-acetate. The oxygen radical production in macrophages from moderately or severely inflamed mucosa was reduced by median 69% (range 22%-79%, p < 0.027) after depletion of CD14+ cells, reaching a level similar to that found for virtually normal samples from the same IBD patients. Furthermore, this production did not increase significantly in mucosal macrophages from normal reference mucosa and from virtually normal or inflamed IBD mucosa after priming with interferon gamma with or without addition of lipopolysaccharide. Upregulation of a respiratory burst in subepithelial resident macrophages os not a likely pathogenetic step in IBD. The increased oxygen radical production shown by macrophages from IBD lesions can, however, be ascribed to recently extravasated CD14+L1+ monocyte-like cells. Inhibition of extravasation of these reactive cells may form part of a therapeutic approach in the future.

Antigens, Surface↗
PubMed1995

Troublesome colostomies and urinary stomas treated with suction-assisted lipectomy.

OBJECTIVE: To investigate the effectiveness of liposuction as treatment in troublesome colostomies and urinary stomas in selected patients. DESIGN: Open clinical study. SETTING: University hospital, Norway. SUBJECTS: 8 consecutive patients with colostomies (n = 2) or urinary stomas (n = 6) who required treatment with liposuction above or around the stoma, mainly for leakage. INTERVENTIONS: Syringe-assisted liposuction under local anaesthesia. MAIN OUTCOME MEASURES: Change in stoma function, particularly reduction in the incidence of leakage, and by the patients' satisfaction graded according to a four point scale. RESULTS: All patients noted considerable improvements in stoma function, or abdominal contour, or both. CONCLUSION: Troublesome colostomies and urinary stomas can in selected patients be successfully treated with liposuction above or around the stoma.

Adult↗
PubMed1993

[Rectal prolapse. Experiences with rectopexy and Delorme's operation].

During the period 1982-91, 52 patients were treated for rectal prolapse. We present the results for 25 treated with Delorme's operation and 14 with rectopexy, all of whom were observed for more than 12 months after operation. Four patients who had internal prolapse were treated with rectopexy. Eight (15%) of 52 patients had postoperative complications, including six in the Delorme group and two in the rectopexy group. A 75 year-old woman operated with rectopexy died from peritonitis. Eight patients (32%) developed recurrent prolapse after Delorme's operation. Five of these were successfully reoperated. No patients in the rectopexy group had a recurrent prolapse. Incontinence and bleeding were reduced in both groups. Despite a relatively high rate of recurrence, we consider Delorme's operation to be a good alternative, also for old debilitated patients, and to involve a minimal risk of serious complications. If recurrence occurs, reoperation can be carried out with good results.

Adult↗
PubMed1993

Radiology of the ileal J-pouch-anal anastomosis (IPAA).

Forty-four consecutive patients operated on with ileal J-pouch-anal anastomosis (IPAA) and diverting ileostomy were examined with barium contrast medium of the pouch before closure of the ileostomy. CT was performed in 4 of the patients. The anatomy of the ileal reservoir as well as complications were assessed. As normal postoperative anatomy we found a "blind loop" at the upper part of the reservoir in 29 patients and a contrast lucency at the anastomosis between the anal channel and the pouch in 5 patients. Complications were revealed at barium contrast medium examinations in 13 patients, including stenoses at the anastomosis between the pouch and the anal channel in 8 patients and fistulas in 5 patients. CT was especially valuable in the exact diagnosis and location of a pelvic abscess in 3 patients, none of which was shown at pouchography.

Adolescent↗
PubMed1992

Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors.

Seventy-five patients with advanced abdominal carcinoid tumors (65 midgut, 10 others) have been examined retrospectively to evaluate the role of surgical treatment as a principle, irrespective of stage of disease. Eighteen of 52 patients (35%) exhibited the carcinoid syndrome. Two or more primaries were found in 39% of patients with midgut lesion, 81% of these patients had regional metastases, 5% of these patients had distant lymph node metastases, and 74% of the patients had liver secondaries. All patients underwent operation, an additional 34% of the patients had a further reoperation, 9% of the patients had a second reoperation, 3% of the patients had a third reoperation, and one patient (2%) had a fourth reoperation. Intraoperative debulking (liver excluded) was performed in 33% of the patients, and 48% of the patients had treatment (resection, hepatic artery ligation, embolization) directed at the liver. The postoperative mortality rate was 2% after the primary operation for midgut lesions. The median survival for midgut tumors was 92 months, compared to 40 months for other lesions (not significant). A significantly higher survival rate was revealed for those patients with midgut lesion who were undergoing intraabdominal debulking procedures (liver excluded); median survival was 139 months versus 69 months without debulking. For those patients with liver metastases, median survival after intervention was 216 months and 48 months without such treatment (p less than 0.001). It is concluded that resection of intraabdominal carcinoid tumor masses can be performed in a high proportion of patients. Despite the retrospective, uncontrolled nature of this study, the difference in survival probabilities in favor of aggressive surgical therapy is so marked that it is not unreasonable to conclude that surgery has played a role in prolonging life in these patients.

Adolescent↗
PubMed1991

[Laparoscopic appendectomy].

Laparoscopic techniques have extended into the operative field of surgery. Appendectomies can be performed laparoscopically. The diagnosis of appendicitis is established and the inflamed organ removed directly. The laparoscopic technique reduces the incidence of unnecessary appendectomies and corresponding morbidity. Compared with conventional appendectomy, laparoscopy leads to less post-operative pain and inability to work. We discuss the first nine patients we treated in this way.

Adult↗
PubMed1991

Association between DNA ploidy pattern and cellular atypia in colorectal carcinomas. A new clinical application of DNA flow cytometric study?

Fresh tissue specimens from 406 colorectal carcinomas were analyzed by DNA flow cytometric study, and the DNA ploidy pattern was compared with Dukes' stage, histologic grade, and degree of cellular atypia. Sixty-one percent of the carcinomas had a distinct aneuploid DNA pattern. The proportion of aneuploid carcinomas was significantly higher in the advanced Dukes' stages than in the localized ones. A highly significant association was found between DNA ploidy pattern and degree of cellular atypia, whereas no association was demonstrated between DNA ploidy pattern and histologic grade. This finding might indicate that cellular atypia has a stronger prognostic impact than the growth pattern of the tumor. The authors suggest that flow cytometric DNA quantification may replace assessment of cellular atypia in the histologic evaluation. Furthermore, together with earlier findings by others, these results indicate that the degree of cellular atypia may be conserved during the development from adenomas to carcinomas.

Adenocarcinoma↗
PubMed1991

Bile duct cysts in adults. Pitfalls in diagnosis and management.

Six women have been referred to us for treatment of bile duct cysts during the past 6 years. In three patients the disorder was misdiagnosed by the referring institution, and they were admitted because of continuing severe symptoms; two of them had been treated with internal drainage procedures which led to unnecessary treatment delay and complications. Two patients had developed cyst carcinoma, the most feared complication of cyst disease. It is concluded that clinical symptoms are nonspecific, and the diagnosis is only ascertained after complete cholangiographic imaging of the biliary tree. Primary cyst excision and hepaticojejunostomy is the treatment of choice.

Adult↗
PubMed1990

[Pancreatic duct prosthesis].

Endoprothetic stenting of the pancreatic duct is reported in limited series. Twelve patients are presented here. In five patients with confirmed or suspected pancreatic malignancy, pain and diarrhea subsided or disappeared, and two patients had a temporary gain in weight. Four patients with chronic pancreatitis all experienced relief of symptoms. One patient with a pancreatic abscess improved temporarily. A postoperative pancreatic fistula healed within two weeks. One patient with a stone in the pancreatic duct became temporarily free from pain. Two patients had minor complications. Efficiency of pancreatic drainage is difficult to evaluate. However, all our patients seemed to benefit from the treatment.

Aged↗