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Biomedical subjects

A Kruse

Publications and source records attributed to A Kruse.

At least 91 records · Page 5Linked to original sources
PubMed1997

Complications of percutaneous endoscopic gastrostomy.

OBJECTIVE: To report our experience of percutaneous endoscopic gastrostomy with particular reference to complications and tube dysfunction. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: 135 patients who required 178 gastrostomy tubes between 1.1.1990 and 30.6.1994. INTERVENTION: 101 patients had the tubes inserted by the introducer technique and 34 by the pull-through method. MAIN OUTCOME MEASURES: Complications and incidence of tube dysfunction. RESULTS: The overall complication rate was 43/135 (32%), including tube dysfunction; 17 (13%) developed a serious complication (intraperitoneal leakage, wound infection, or subcutaneous emphysema) and 6 died (4%). In each case the introducer had been used. 28 patients (21%) had a non-functioning tube exchanged sometimes more than once. The mean life-span of the tubes were 3.8 months, and seemed to be independent of the technique chosen for introduction. 66 patients (49%) died with a functioning tube. 24 (18%) died within a month of the insertion. CONCLUSION: serious complications leading to laparotomy, wound infection, or intraperitoneal abscess developed in 17 patients (13%), in all of whom the introducer technique had been used. The safer pull-through technique is therefore recommended.

Adolescent↗
PubMed1997

[Emotionality, age and aging--research perspectives, methodological approaches and empirical results].

The topic of emotionality can be regarded as a frame of reference for different perspectives in psycho-gerontological research. In the first chapter five facets of the meaning of emotionality are distinguished: emotionality as a trait, emotionality as an attribute describing actual subjective experiences, emotionality as an attribute describing coping with (stressful) experiences and life events or as a consequence of coping activity, emotionality as a result of self-regulating processes and as an attribute describing feelings of subjective well-being in old age. In a further step methodological approaches for these different facets of meaning are described. In the third chapter empirical results of three research questions are reviewed: How do people perceive old age and how do they perceive the process of aging? Do well developed or regressive coping techniques become more important in old age? Which dimensions of personality are the best predictors of life satisfaction and perceptions of the process of aging? Results of our own research on two specific aspects of emotionality in old age are described in detail in the last part of this contribution: How do sensations of pain and limits of independent living in old age influence life satisfaction and perceptions of the process of aging? How do Jewish extermination camp survivors cope with the increasing reminiscence of holocaust-traumatization?

Activities of Daily Living↗
PubMed1996

[Esophagoscopy in patients with angina pectoris and normal coronary arteriography].

The clinical value of oesophago-gastro-duodenoscopy and distal oesophageal biopsies was investigated in 49 patients with angina pectoris and normal coronary angiograms. The results were compared to 24 hour oesophageal pH-monitoring of the patients and of a control group of 22 healthy sons. Macroscopic esophagitis--mainly grade I was found in 31% of the patients and microscopic oesophagitis in 25%. The only major abnormalities were the identification of three peptic ulcers (6%). Median (range) reflux index was 1.3 (0.0-13.4) in the patient group and 2.1 (0.0-9.9) in the controls (p = 0.49). There were no differences with respect to endoscopical findings or reflux index between patients with a positive and patients with a normal exercise electrocardiogram. At a median 36 months post study 38% of the patients had undergone acid secretion inhibitor treatment with an effect on symptoms in only 4%. The study provides evidence that routine oesophago-gastro-duodenoscopy is of limited value in this patient group.

Adult↗
PubMed1996

Direct cholangiography and biliary drainage.

Direct cholangiography by percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography has greatly improved diagnostic work-up of patients with known or suspected biliary obstruction. These diagnostic procedures were introduced in Denmark in the early 1970s, and technical refinements and clinical research of the methods were initiated. The Danish contribution led to definition of indications for direct cholangiography and general acceptance of the methods in daily clinical practice; nationally as well as internationally. The transhepatic cholangiography with selective catheterization of the biliary ducts permitted external drainage of obstructed ducts. The disadvantages of this technique inspired the innovation of internal biliary drainage and the invention of the biliary endoprosthesis. The endoscopic approach to the biliary tract and the technical improvements of accessory instruments led to the early introduction of therapeutic procedures, i.e. papillotomy, stone removal, biliary drainage and treatment of strictures and post-traumatic lesions. Experimental and clinical research with endoprostheses improved their function and prevented dislodgment. Clinical research documented that biliary drainage by endoprosthesis is a valuable alternative to surgical bypass in patients with inoperable biliary obstructions. Endoscopic therapeutic procedures for common bile duct stones have almost replaced conventional surgical treatment. Endoluminal imaging techniques are under evaluation and may contribute to future improvements.

Bile↗
PubMed1996

Endoscopic treatment of oesophagoairway fistula with oesophageal balloon prosthesis.

OBJECTIVE: To describe our experience with a cuffed oesophageal prosthesis in the management of malignant oesophagoairway fistulas. DESIGN: Retrospective study. SETTING: Teaching hospital, Denmark. SUBJECTS: Nine patients treated with a balloon cuffed oesophageal prosthesis during the period 1987-93. MAIN OUTCOME MEASURES: Endoscopic assessment of the fistula compared with the results and complications of treatment. RESULTS: The prosthesis were inserted without complications. Eight patients had total relief of aspiration and were able to eat a semisolid diet. Three patients needed reintervention. Patients with little or no stenosis of the tumour seemed to be at considerable risk of dislodgement of the tube and those with large fistulas developed protrusion of the balloon into the tracheal lumen. CONCLUSION: Intubation with the cuffed oesophageal prosthesis is safe and relatively inexpensive. Other treatments should be considered in patients with minor stenosis of the tumour or a large fistula.

Adult↗
PubMed1995

Pentoxifylline therapy in HIV seropositive subjects with elevated TNF.

Tumor necrosis factor-alpha (TNF-alpha) is thought to induce cachexia in subjects infected with human immunodeficiency virus (HIV), and it has been suggested that HIV-seropositive patients would benefit from treatment with pentoxifylline, a known suppressor of TNF-alpha production. The purpose of the present study was to examine how pentoxifylline at a dose of 800 mg thrice daily would influence the cellular immune system in HIV-seropositive persons with elevated TNF-alpha. Six HIV-seropositive subjects with elevated amounts of TNF-alpha in plasma at least at two occasions were included in an open, controlled, randomized, cross-over study consisting of a 6 week treatment period and a 6 week control period. Blood samples were collected before and at the end of each period. Pentoxifylline treatment did not influence the concentration of plasma-TNF-alpha, subpopulations of blood mononuclear cells, the proliferative responses nor the natural killer (NK), and lymphokine activated killer (LAK) cell activities. Furthermore, pentoxifylline treatment did not influence the weight, temperature, well being, or tiredness of the subjects. However, the patients frequently reported gastrointestinal side effects. In vitro, however, pentoxifylline at suprapharmacological concentrations inhibited the blood mononuclear cell (BMNC) proliferative responses, NK, and LAK cell activities.

Adolescent↗
PubMed1995

Production of interferons and lymphokines in leukocyte cultures of patients with schizophrenia.

Recently, several lines of evidence have suggested the possible of immunological dysfunction in the pathogenesis of schizophrenia. We therefore investigated the ability to produce interferons and lymphokines in response to mitogenic or viral stimulation in a whole blood assay of 37 schizophrenic patients (DSM-III-R) and of 42 healthy blood donors. Phytohaemagglutinin (PHA) was used for the induction of interleukin-2 (IL-2), interferon gamma (INF gamma), interleukin-6 (IL-6) and the soluble interleukin-2 receptor (sIL-2R) and Newcastle Disease Virus (NDV) for the induction of interferon alpha 2 (INF alpha 2). All lymphokines and, in addition, the sIL-2R in the sera were determined by ELISA technique. The psychopathological status of the patients was assessed by psychiatrists according to internationally accepted standards. The patient group showed a trend to lower levels of the interferons alpha 2 and gamma and a significant decrease of IL-2 production. The sIL-2R levels were significantly increased in the sera of schizophrenic patients. The latter increase was associated with a poor assessment of prognosis (Strauss and Carpenter). This association appears to be of interest. However, its significance is not understood, since longitudinal studies could not be performed.

Adult↗
PubMed1995

Hands-on endoscopy training: an evaluation of the SADE endoscopy course. Scandinavian Association of Digestive Endoscopy.

The Scandinavian Association of Digestive Endoscopy course in advanced practical endoscopy has been arranged on a regular basis since 1980, representing a joint Scandinavian effort to offer hands-on endoscopy training with expert supervision at major endoscopy centers. The course has been aimed at gastroenterologists with previous endoscopic experience, focusing on special techniques, practical hints and expert solutions in special cases. Three days of practical training throughout Scandinavia are completed with two days of review lectures, case reports and special techniques. An inquiry among previous course participants indicates that the course has indeed been of practical value for their daily work, and that personal training as well as watching "experts at work" were useful for their ensuing endoscopic practice. The course model does, however, require close co-operation with the endoscopy units hosting the practical part of the course.

Curriculum↗
PubMed1995

Upper endoscopy in patients with angina and normal coronary angiograms.

BACKGROUND AND STUDY AIMS: It has been recommended that patients with angina, a normal coronary angiogram, and no other signs of heart disease, should be evaluated using esophagogastroduodenoscopy before referral to dynamic esophageal investigations. The aim of the present study was to investigate the clinical value of upper endoscopy in this patient group. PATIENTS AND METHODS: Forty-nine consecutive patients (28 women aged 18-70 years, mean 51.6 years) with angina-like chest pain and a normal coronary angiogram, who were referred to a tertiary cardiologic center, were included in a prospective study. Upper endoscopy with distal esophageal biopsies was performed. The results were compared with 24-hour pH monitoring. At a median of 36 months after discharge, the patients were asked to complete a follow-up questionnaire. RESULTS: Macroscopic esophagitis was found in 15 patients (31%), and microscopic esophagitis in 11 (25% of the patients who underwent esophageal biopsy). One patient had macroscopic grade II esophagitis, and the rest had grade I esophagitis. The only major abnormalities were three peptic ulcers (6%). Five patients had symptoms of gastroesophageal reflux, but the 24-hour pH monitoring revealed an abnormal reflux index in only one. The median reflux index was 1.3 (range 0.0-13.4) in the patient group and 2.1 (range 0.0-9.9) in a control group (n = 22; p = 0.49). Patients with positive and normal exercise electrocardiography did not differ in terms of the endoscopic findings or reflux index. At the post-study follow-up, 38% of the patients had undergone acid secretion inhibitor treatment, with an effect on symptoms in only 4%. CONCLUSIONS: The study provides evidence that routine esophagogastroduodenoscopy is of limited value in this group of patients.

Adolescent↗
PubMed1995

Hyperprolactinaemia in patients with pituitary adenomas. The pituitary stalk compression syndrome.

Hyperprolactinaemia, unexplained by prolactin-production of the tumour is occasionally found in patients with pituitary tumours. This secondary hyperprolactinaemia has been ascribed to a mass effect of the tumour upon the pituitary stalk, obstructing the normal inhibitory hypothalamic influence on the prolactin producing cells. In this study the adenoma volume, amount of suprasellar enlargement of the tumour and the intrasellar pressure were measured in 42 patients operated upon consecutively for pituitary tumours. Secondary hyperprolactinaemia was found in six (14%). There was no difference as regards adenoma volume, amount of suprasellar extension or intrasellar pressure between the group of patients with elevated p-prolactin versus the group with normal p-prolactin. We conclude that mechanisms other than pituitary stalk compression must be considered as the cause of secondary hyperprolactinaemia.

Adenoma↗
PubMed1995

Failure to detect type 1 interferon production in human umbilical cord vein endothelial cells after viral exposure.

Cytokine production by endothelial cells is known to occur after the reception of signals such as interleukin-1 (IL-1) and tumor necrosis factor (TNF). In the present study, we demonstrate cytokine release and upregulation of adhesion molecule expression of human endothelial cells derived from umbilical cord veins in response to stimulants. The cells were exposed to the plant lectin phytohemagglutinin A (PHA), the viral inducers Newcastle disease virus (NDV) and Sendai virus, and the nucleic acid analog polyinosinic/polycytidylic acid (polyI:C). All stimulants induced expression of IL-1 beta and IL-6. The titers of these cytokines were comparable to those obtained in human leukocytes, whereas no TNF-alpha release was detectable. A further feature of activation was upregulation of intercellular adhesion molecule 1 (ICAM-1), which was analyzed after contact with these stimulants. These experiments revealed an increased expression of ICAM-1 in response to all stimulants tested. A major part of our studies was devoted to the ability of endothelial cells to produce interferons as an important function of a number of cell types in response to viral infections. To ensure stimulation of the cells, the inducers NDV, Sendai virus, and polyI:C were analyzed. Expression of interferon (IFN) was not detected, although viral inducers mediated the release of IL-1 beta and IL-6, suggesting that endothelial cells are quite responsive to these stimulants. In conclusion, these findings show that the ability of endothelial cells to secrete cytokines is not restricted to mediators of the immune system, such as IL-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Cells, Cultured↗
PubMed1995

Determination of the number of Epstein-Barr virus genomes in whole blood and red cell concentrates.

The risk of Epstein-Barr virus (EBV) infection after blood transfusion has been controversially discussed. Little is known about EBV transmission via buffy-coat-depleted red cell concentrates (RCC). In this study, we determined the number of EBV genomes in RCC of EBV-seropositive donors in comparison to whole blood. RCC were prepared from whole blood donations by using the 'top and bottom system'. Leucocyte content was significantly reduced in RCC in comparison to whole blood (0.47 x 10(9) vs. 2.3 x 10(9) per unit; P < 0.001). As B cells are expected to harbour EBV genomes, we analysed the number of B lymphocytes in both types of blood products. There was a significant reduction of B cell content from a median value of 90 x 10(6) in whole blood to 0.2 x 10(6) in RCCs (P < 0.001). The number of EBV genomes was estimated at a median value of seven from 10(6) B cells in the peripheral blood of healthy, EBV-seropositive blood donors by means of a polymerase chain reaction (PCR) assay. By calculation, one unit of RCC may contain an average of one to two EBV genomes, in contrast to a whole blood unit, which is likely to harbour an average of 600 to 700 EBV genomes. It is concluded that the use of leucocyte depletion systems significantly reduces the number of EBV genomes in erythrocyte concentrates. Thus, leucocyte reduced blood products appear to minimize the risk of EBV infection.

B-Lymphocytes↗
PubMed1995

Cytokine production in a whole-blood assay after Epstein-Barr virus infection in vivo.

Epstein-Barr virus (EBV) has a marked tropism for cells of the immune system, and infection can result in profound immunomodulatory effects. In order to examine the role of cytokines during the acute phase of infectious mononucleosis, we studied the levels of different interleukins (ILs), interferons (IFNs), and the soluble IL-2 receptor (sIL-2R) in serum samples of 20 patients. We found elevated levels of IL-2, IL-6, sIL-2R, and IFN-gamma. Whereas the peak of IL-2 and IL-6 concentration occurred during the first week (P < 0.01), the largest amounts of sIL-2R were measured during the second week (P < 0.01). IFN-gamma levels were only enhanced during the first week. In addition, we investigated the ability to produce cytokines in response to mitogenic stimulation in a whole-blood assay of 11 patients compared with healthy blood donors. In the whole-blood assay of patients compared with controls after stimulation with lipopolysaccharide, we measured more than 10-fold elevated levels of tumor necrosis factor alpha (P < 0.01), 3-fold elevated levels of IL-1 beta (P < 0.01), and about 2-fold increased amounts of IL-6 (P < 0.01). A significant enhancement in sIL-2R and IFN-gamma concentration was found in the assay after stimulation with phytohemagglutinin after 24 h of incubation (P < 0.01). Collectively, our data seem to indicate that monocytes are strongly activated during infectious mononucleosis. Monocytes and monocyte-derived factors may play an important role in the pathogenesis of infectious mononucleosis and, together with T lymphocytes, may be partly responsible for clinical symptoms.

Adult↗
PubMed1994

[Endoscopic treatment of bile leakage following biliary tract surgery].

Thirty-two patients aged 15-89 years developed postoperative bile leakage. Twenty-eight had undergone cholecystectomy, with choledocholithotomy in 11, and four had had miscellaneous operations. Endoscopic retrograde cholangiopancreatography (ERCP) showed leakage from the cystic stump in 19 cases, from the T-tube track in five, from gallbladder and liver abscess in two and from major bile ducts in 6 cases. Major bile duct lesions were only mapped, but not managed endoscopically, whereas the remaining 26 patients were treated successfully with internal stenting (22) or endoscopic sphincterotomy (four). One patient developed cholangitis and was managed by antibiotics, no other complications were related to the procedures. ERCP procedures are effective for the most common causes of postoperative bile leakage and ought, therefore, to be the method of first choice for dealing with bile leakage.

Adolescent↗
PubMed1994

Effect of omeprazole and sucralfate on prepyloric gastric ulcer. A double blind comparative trial and one year follow up.

This study compared healing rates, relief of symptoms, frequency of adverse events, and proportion of patients in remission after one year follow up in 104 patients with active prepyloric ulcer during treatment with 40 mg omeprazole once daily or 2 g sucralfate twice daily, using a randomised double blind controlled trial. Healing rates after two, four, and six weeks were (omeprazole/sucralfate) 49%/23%; 83%/59%; 90%/70% respectively. After two weeks, omeprazole was more efficient than sucralfate in relief of daytime and nocturnal epigastric pain, nausea, and heartburn. The proportion of patients in remission after one year follow up was significantly higher in the omeprazole group (p < 0.01). Of the healed patients ulcers recurred in 36% in the omeprazole group and in 46% in the sucralfate group. It is concluded that the ulcer healing rate was higher and symptom relief was more pronounced in the omeprazole group compared with the sucralfate group, and that more patients were still in remission after a one year follow up period.

Adult↗
PubMed1994

Endoscopic manometry of the sphincter of Oddi and the pancreatic and biliary ducts in patients with chronic pancreatitis.

Sphincter of Oddi activity and the common bile duct (CBD) and pancreatic duct (PD) pressures were measured by means of endoscopic manometry in 15 patients (11 men and 4 women aged 18-77 (median, 40) years) with various degrees of chronic pancreatitis. Eleven of the 15 patients studied had an abnormal manometric pattern: elevated base-line pressures were seen in 8 patients, elevated duct pressures in 6 patients, abnormal peristalsis in 6 patients, and discoordination in 4 patients. There was no relation between the severity of chronic pancreatitis as shown by endoscopic retrograde pancreatography and the pancreatic function test and the manometric findings. However, a positive correlation between the sphincter of Oddi base-line pressure and the pancreatic duct pressure was found. It is concluded that manometric abnormalities are common findings in patients with chronic pancreatitis. Whether this is primary or secondary to the inflammatory process is still uncertain.

Adolescent↗