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Biomedical subjects

A Kruse

Publications and source records attributed to A Kruse.

At least 145 records · Page 8Linked to original sources
PubMed1989

Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice.

In patients with obstructive jaundice caused by malignant stricture of the extrahepatic bile duct we compared survival time, complication rates, hospitalisation requirements, and quality of life after palliation by endoscopic endoprosthesis or bypass surgery. During diagnostic endoscopic cholangiography 50 patients were randomised to the two treatment alternatives. All 25 patients randomised to endoprosthesis were treated by this procedure, whereas only 19 of 25 patients randomised to bypass surgery underwent operative biliary-digestive anastomosis. Life table analysis revealed no difference in survival between treatment groups or randomisation groups. No differences were found when other variables were compared. We conclude, that palliation of obstructive jaundice in malignant bile duct obstruction with endoscopically introduced endoprosthesis is as effective as operative bypass.

Aged↗
PubMed1989

Continuous measurement of gastric blood flow by laser-Doppler flowmetry during gastroscopy.

Endoscopic laser-Doppler flowmetry (LDF) of gastric blood flow (GBF) was performed simultaneously with intragastric manometry to detect a possible correlation between GBF and luminal pressure during gastroscopy. By increasing luminal air pressure from 10 to 20 cm H2O a significant reduction in GBF was observed. Regional differences in GBF were also demonstrated. Variations in luminal air pressure have a significant influence on GBF as measured by LDF, and therefore intragastric manometry and standardization of intraluminal air pressure is necessary in endoscopic LDF measurements.

Adult↗
PubMed1989

Controlled clinical trial with sucralfate in the treatment of macroscopic gastritis.

The efficacy of sucralfate in the treatment of patients with dyspepsia and macroscopic signs of gastritis was assessed in a double-blind, placebo-controlled study. Treatment was 2 g sucralfate or placebo taken 1/2 h before breakfast and at bedtime. Clinical and endoscopic examinations were performed after 6 weeks' treatment, and if mucosal changes and/or symptoms persisted, medication was continued for another 6 weeks. Cumulative healing rates at 6 and 12 weeks were 43% (13 of 30) and 62% (18 of 29) in the sucralfate group verus 37% (11 of 30) and 62% (18 of 29) in the placebo group. Corresponding rates for symptomatic improvement were 80% and 83% for those receiving sucralfate and 73% and 79% for placebo-treated patients. None of the differences between sucralfate and placebo were significant, and sucralfate does not seem to be superior to placebo in the treatment of macroscopic gastritis.

Adolescent↗
PubMed1989

Clinical significance of manometric assessment of both pancreatic duct and bile duct sphincter in the same patient.

In this study both pancreatic and bile duct sphincter pressures were measured on the same occasion by means of endoscopic manometry in 42 patients with long-standing upper abdominal pain. Nine (53%) of the 17 patients with abnormal sphincter function had a marked difference between the pancreatic duct sphincter pressure (PSOP) and the bile duct sphincter pressure (BSOP): 6 patients with a clinical diagnosis of biliary dyskinesia showed elevated BSOPs, whereas the PSOPs were normal. The reverse, an abnormal PSOP but normal or only a slightly elevated BSOP, was registered in the three patients with chronic pancreatitis. These findings indicate that a motor abnormality may be restricted to only one of the sphincters. Thus, when the sphincter of Oddi is investigated only from the pancreatic duct, manometry may either fail to show an abnormal BSOP in some patients with biliary dyskinesia, or it may falsely suggest this diagnosis in patients with unrecognized pancreatitis.

Adult↗
PubMed1989

Large bile duct stones treated by endoscopic biliary drainage.

One hundred five patients with obstructive jaundice and cholangitis (49 patients), referred for diagnostic endoscopy, were found to have inextractable bile duct stones. Median age was 76 years and three quarters were more than 72 years of age. Insertion of an endoprosthesis with or without a sphincterotomy relieved jaundice in 94% and settled cholangitis in 90%. Antibiotic cover during the procedure seems essential inasmuch as pyrexia and septicemia occurred in 6 of 57 cases where it was not given. One case was lethal. Another patient died of acute pancreatitis. The patients were old. One quarter died before the follow-up, 1 to 5 years after the initial intervention. The results indicate that the combination of endoscopic sphincterotomy, insertion of an endoprosthesis, and, if feasible, stone extraction on a later occasion when the acute phase of the illness had subsided brought the disease sufficiently under control among three quarters of the patients with large common duct stones or stenoses in the biliary tract. One quarter of the patients were treated surgically. This was accomplished without mortality, but morbidity was not negligible. A policy with a surgical approach restricted to selected cases with persistent symptoms in spite of sufficient endoscopic drainage is recommended.

Adult↗
PubMed1988

The pituitary-thyroid axis in acromegaly.

The pituitary-thyroid axis of 12 acromegalic patients was evaluated by measurement of the serum concentrations (total and free) of thyroxine (T4), triiodothyronine (T3) and reverse T3 (rT3) and thyrotropin (TSH), growth hormone (GH) and prolactin (PRL) before and after iv stimulation with thyrotropin releasing hormone (TRH). Using an ultrasensitive method of TSH measurement (IRMA) basal serum TSH levels of the patients (0.76, 0.07-1.90 mIU/l) were found slightly, but significantly (P less than 0.01), lower than in 40 healthy controls (1.40, 0.41-2.50 mIU/l). The total T4 levels (TT4) were also reduced (84, 69-106 nmol/l vs 100, 72-156 nmol/l, P less than 0.01) and significantly correlated (P less than 0.02, R = 0.69) to the TSH response to TRH, suggesting a slight central hypothyroidism. The acromegalics had, however, normal serum levels of TT3 (1.79, 1.23-2.52 nmol/l vs 1.74, 0.78-2.84 nmol/l, P greater than 0.10), but significantly decreased levels of TrT3 (0.173, 0.077-0.430 nmol/l vs 0.368, 0.154-0.584 nmol/l, P less than 0.01) compared to the controls. The serum concentration of the free iodothyronines (FT4, FT3, FrT3) showed similar differences between acromegalics and normal controls. All the acromegalics showed a rise of serum TSH, GH and PRL after TRH. Positive correlation (P less than 0.05, R = 0.59) was found between the TSH and GH responses, but not between these two parameters and the PRL response to TRH. These findings may be explained by the existence of a central suppression of the TSH and GH secretion in acromegalic subjects, possibly exerted by somatostatin. Euthyroidism might be maintained by an increased extrathyroidal conversion of T4 to T3.

Acromegaly↗
PubMed1988

Creatine kinase BB release into cerebrospinal fluid after lateral ventricle cannulation.

Creatine kinase (CK) and creatine kinase BB isoenzyme (CK-BB) activities were measured in ventricular CSF obtained by lateral ventricle cannulation in patients suspected of normal pressure hydrocephalus. Lateral ventricle cannulation resulted in highly and variably elevated CK and CK-BB levels. The results emphasise the interference of these CK and CK-BB elevations in studies on the prognostic value of CSF CK and CK-BB levels in head trauma patients with respect to outcome.

Catheterization↗
PubMed1987

Endoscopic biliary drainage.

Endoscopic biliary drainage (EBD) has become an established method of relieving posthepatic jaundice. This study comprises 399 patients in whom 472 EBD procedures were performed during a 5 year period; 272 patients had malignant obstruction, 36 had a benign stricture, 79 had common duct stones and 12 patients had other benign conditions requiring drainage. A 7F double pigtail endoprosthesis was used in the majority of patients and was inserted with an Olympus JF-1T duodenoscope. Ninety-two per cent of the prostheses were correctly positioned, and 88 per cent of these functioned well with relief of symptoms. The 30-day mortality was 22 per cent and one-third of these deaths were due to the procedure, septicaemia being the dominant hazard. This was more marked if the obstruction was not relieved satisfactorily. Antibiotic cover was not used routinely and had not been prescribed in any of the fatal cases. This omission probably made a significant contribution to the septicaemia. Acute pancreatitis and haemorrhage were rare complications and both were probably related to the coincidental sphincterotomy. Prostheses intended for permanent relief of malignant obstruction remained patent for 2-3 months (median) with a wide range of 1-618 days. Survival among these patients is so short, that one or two EBD procedures will keep the majority of patients free from symptoms related to biliary obstruction, and only two patients needed more than three procedures. Fifty-one patients with pancreatic head carcinoma had EBD as a bypass before an intended operation. Only 16 patients actually had a resection. The median survival among the 51 patients was 106 days (compared with 59 days among 100 patients with a permanent prosthetic bypass). Only one patient with a very small periampullary carcinoma has survived for more than 3 years. Forty-seven patients are dead. Among the 51 patients in whom radical resection was intended two-thirds were actually treated by permanent surgical or prosthetic bypass.

Adenoma, Bile Duct↗
PubMed1987

Observer variability in assessment of angiographic vasospasm after aneurysmal subarachnoid haemorrhage.

In clinical practice and in many reported studies about incidences and time courses of vasospasm the angiographic spasms are judged by eye without clear definition of vessel narrowings. To evaluate the reliability of this diagnostic method two experienced neuroradiologists and two experienced neurosurgeons independently in two sessions, examined 30 carotid angiograms performed after an aneurysmal subarachnoid haemorrhage. The intra- and inter-observer agreements for the absent/present and localization diagnosis of vasospasm were calculated by means of Kappa statistics. Kappa values for both intra- and inter-observer agreement showed great variability and in general most of the agreements were not much better than chance expected agreement. The diagnostic method of judging angiographic vasospasm by eye without clear-cut definitions of vessels narrowings is unreliable and should not be used in the future, neither in clinical practice nor in research.

Cerebral Angiography↗
PubMed1987

Endoscopic sphincter of Oddi manometry in healthy volunteers.

This study evaluates the endoscopic manometric findings within the sphincter of Oddi (SO) in nine healthy volunteers premedicated with atropine 1 h before and with diazepam during the investigation. We measured the bile duct sphincter in seven persons and the pancreatic duct sphincter in two. A hydraulic capillary infusion system and a triple-lumen catheter were used. In all the SO was identified as a zone (median length, 8 mm) with elevated base-line pressure and superimposed phasic activity. Median values for amplitude was 102.9 mm Hg; base-line pressure, 10 mm Hg; wave duration, 4.8 sec; and frequency, 2.6/min. Most waves propagated antegrade or simultaneously, and in no individual were more than one third of the waves retrograde. When peak-to-peak intervals were analyzed in one volunteer with prolonged manometry, a basal mode of 6 sec or an even multiple of this value was disclosed, indicating that the SO is paced.

Adolescent↗
PubMed1987

Manometric activity of the pancreatic duct sphincter in patients with total bile duct sphincterotomy for sphincter of Oddi dyskinesia.

Previous anatomical studies have described a distinct sphincteric structure at the entrance of the common bile and pancreatic ducts in the duodenum. However, from an anatomical point of view, the pancreatic duct sphincter is only present in one third of human specimens. The purpose of the present study was therefore to investigate whether sphincteric activity could be demonstrated in patients in whom the common bile duct sphincter was completely transsected during endoscopic sphincterotomy. Twelve patients had a complete bile duct sphincterotomy because of sphincter of Oddi dyskinesia. The sphincterotomy was checked manometrically in all, and neutralization of the choledochoduodenal gradient recognized. In all patients a distinct pancreatic sphincteric zone with base-line elevation and superimposed phasic activity was demonstrated. In six patients the pancreatic duct sphincter was studied before and after bile duct sphincterotomy, and, although a definite sphincter zone still was present in the pancreatic duct, a reduction in phasic wave amplitude was observed. A similar decreased base-line and pancreatic duct pressure was observed, although not statistically significant.

Adult↗
PubMed1987

Sucralfate in gastritis.

Gastritis has a wide spectre of definition modalities. Most previous studies have compared symptomatology with histologic gastritis with negative results. We believe that this may be due to inadequate definition criteria and emphasize this point by comparing gastroesophageal reflux with duodenogastric reflux. A prospective randomized trial has been conducted for half a year comparing Sucralfate with a placebo in patients with symptomatological and macroscopical gastritis. Although approximately one hundred patients met the endoscopic criteria, the vast majority could not be included due to well-defined interfering diseases, and thus the material is still too sparse to give any indication of the influence of Sucralfate on endoscopic gastritis, although the preliminary overall results seem promising.

Chronic Disease↗
PubMed1987

CSF-dynamics in syringomyelia: intracranial pressure and resistance to outflow.

The several theories on the pathogenesis of syringomyelia have not resulted in the satisfactory selection of those patients who can be treated by CSF diversion. In the present paper three types of syringomyelia are described by case studies. The classification is made by investigation of CSF-dynamics, a measurement of CSF pressure and resistance to outflow of CSF. It is proposed that in a subgroup of patients with syringomyelia the cause is defective CSF resorption and that this group may be selected out and treated accordingly.

Adult↗
PubMed1987

Coping with chronic disease, dying and death--a contribution to competence in old age.

This article reports empirical studies investigating coping with chronic disease, dying and death in the later years. The coping process is seen as a characteristic of "competence" in old age, as the investigations demonstrate that old people are very often able to adjust to crises and restrictions caused by disease, and at the same time maintain a stable perspective. The studies show that coping with chronic disease, dying and death are highly influenced by biography, by subjective evaluation of the past, present and future, and by access to a supportive intra- and extrafamilial network. This article discusses central concepts, such as "competence", "cognitive representation", "future perspective" and "coping", followed by a summary of empirical studies conducted by the author and investigates different groups of patients.

Adaptation, Psychological↗