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Biomedical subjects

B Anderberg

Publications and source records attributed to B Anderberg.

At least 55 records · Page 3Linked to original sources
PubMed1987

Evaluation of cimetidine as an aid in the management of non-variceal massive upper gastrointestinal haemorrhage.

In order to evaluate the effect of H2-receptor blockade as an adjunct to antacid treatment in non-variceal massive upper gastrointestinal haemorrhage, 106 patients were randomized to treatment with either antacid (n = 54) or cimetidine and antacid (n = 52). One patient (antacid group) died as a direct cause of bleeding. Acute surgery was carried out in 8 patients (14.8%) in the antacid group and in 4 patients (7.7%) in the cimetidine-antacid group. Continuous bleeding or re-bleeding occurred in 11 patients (20.4%) in the antacid group and in 10 patients (19.2%) in the cimetidine-antacid group. Neither these differences, nor any differences related to specific source of bleeding, were statistically significant. It is concluded that, according to the regimen applied in the present study, treatment with cimetidine does not to any significant extent influence the immediate outcome for patients with non-variceal massive upper gastrointestinal haemorrhage.

Adult↗
PubMed1987

Endoscopic sphincterotomy in poor-risk patients.

During the period February 1981--February 1986 101 poor-risk patients with common bile duct stones were treated with EST (endoscopic sphincterotomy). 51 of the patients had no previous gallbladder surgery. The first year 7 complications occurred among 11 patients, including 3 deaths. The following four years we had a total of 8 complications among 90 patients, including 1 death. The complications consisted of: Bleeding needing transfusion (n = 5), pancreatitis (n = 5), cholangitis (n = 2), perforation (n = 2), impaction of the Dormia basket (n = 1). Fourty-five patients were discharged without cholecystectomy. Two patients later underwent elective cholecystectomy. Four patients developed symptoms requiring cholecystectomy. The remaining 39 patients have not required any further treatment for their gallstone disease. This study demonstrates that EST in experienced hands is a safe and effective method even in extremely poor-risk patients and that EST might be used as the sole treatment of common bile duct stones in this type of patients without previous cholecystectomy. The few complications are mostly mild and can be managed conservatively.

Adult↗
PubMed1986

Early and late results after antrectomy, selective vagotomy and Roux-en-Y reconstruction for severe peptic ulcer disease.

The Roux-en-Y gastrojejunostomy has become an increasingly used method for gastrointestinal tract reconstruction, and is advocated in the treatment of alkaline reflux gastritis. Since 1979 we have used selective vagotomy, antrectomy and Roux-en-Y reconstruction as the primary method in treating gastric ulcer and complicated duodenal ulcer in 25 patients. In a follow-up study we have evaluated the postoperative course and the long term results. All patients were operated on between 1979 and 1984. Nine patients had a gastric ulcer (GU), 11 a prepyloric ulcer (PPU) and 5 patients had a complicated duodenal ulcer (DU). The clinical results showed a grade Visick I in 48%, Visick II in 44%, Visick III in 4% and a grade Visick IV in 4%. There were no postoperative deaths, but other early complications occurred in 9 patients (36%). At follow-up, endoscopy showed signs of delayed emptying in 5 patients, but only 1 had corresponding symptoms. Mild to moderate symptoms of dumping were found in 1 patient. There was no case of severe diarrhea. The overall results were satisfactory, indicating that selective vagotomy and antrectomy with Roux-en-Y reconstruction is a valuable alternative as a primary method in the surgical treatment of severe peptic ulcer disease.

Adult↗
PubMed1985

Prophylaxis and management of stress ulcers.

Stress ulcers are located in the body and fundic part of the stomach. They occur in the majority of severely ill or injured patients, but only about 10% will bleed. The most effective prophylaxis are measures against the condition giving rise to risk factors as septicaemia, shock and malnutrition. The medical prophylaxis consists of antacids and/or histamine2-blockers. Most bleedings will stop after intensive care and medication with vasopressin particularly if risk factors can be eliminated. Gastric surgery should be the last step in the treatment of bleeding stress ulcers and then we recommend non-resectional surgery as gastric devascularisation or suture ligation of bleeding vessels.

Antacids↗
PubMed1985

Betablockers compared with antithyroid drugs as preoperative treatment in hyperthyroidism: drug tolerance, complications, and postoperative thyroid function.

Subtotal thyroid resection or hemithyroidectomy was performed for hyperthyroidism on two groups of patients: 84 treated before surgery with antithyroid drugs and thyroxin and 111 given only beta-blocking agents before surgery. These two patient groups were compared with reference to preoperative medication, operation, immediate postoperative course, and late results, with follow-up for 3 to 7 years. The advantages of beta-blockers compared with conventional antithyroid medication were lack of adverse reactions, rapid effect of treatment, considerably shortened preoperative treatment time, and fewer outpatient visits, with consequent financial benefit. No disadvantages of beta-blockers were found except that 18% of the patients required additional propranolol in the immediate postoperative period. There were no surgical complications in either group other than a mild persistent hypocalcemia in two patients from the beta-blocked group. The serum thyrotropin levels during the first 6 postoperative months were significantly higher in the patients treated with antithyroid drugs. The frequency of postoperative thyroid dysfunction showed no intergroup difference during the observation period. Signs of hypofunction, necessitating thyroxin supplementation, were observed in 28.6% of patients in the antithyroid drug/thyroxin group and in 25.7% in the beta-blocker group. Toxic recurrence occurred in 1.8% of the group that received beta-blockers and in 1.2% of the other patients. The study demonstrated that beta-adrenoceptor blockade is a safe method for preoperative treatment in hyperthyroidism, with advantages for patients and regarding costs.

Adrenergic beta-Antagonists↗
PubMed1985

Influence of extradural blockade on serum thyroid hormone concentrations after surgery.

To study the changes in thyroid hormone metabolism after surgery, the influence of neurogenic blockade by extradural local anaesthetics, and possible hormonal interactions, 16 women undergoing cholecystectomy were randomly allocated to two groups of eight each. All patients received general anaesthesia and in addition one group received extradural blockade for 24 h. Preoperatively and at 2, 4, 6, 12 and 24 h after skin incision arterial serum concentrations of thyroid hormones (T3, free T3, rT3, T4, free T4 and TSH), catecholamines (adrenaline and noradrenaline), cortisol and serum proteins (albumin, prealbumin and TBG) were determined. In both groups total T3, free T3, total T4 and TSH decreased significantly whereas free T4 was unchanged and rT3 increased. No differences between the extradural group and the controls regarding thyroid hormones were observed, in spite of suppressed catecholamine and cortisol concentrations in the extradural group as compared to the control group. All serum thyroid hormone binding proteins decreased significantly in both groups. Changes in thyroid hormone metabolism after surgery seem independent of neurogenic blockade by extradural local anaesthetics, and of plasma catecholamine and cortisol concentrations.

Adult↗
PubMed1984

Recurrent rectal carcinoma after anterior resection and rectal stapling.

Nine local recurrences have been diagnosed in 38 patients with carcinoma of the rectum operated on with anterior resection using the EEA-stapling instrument. The characteristics of these recurrences have been compared with those of other authors, currently a total of 27 recurrences. The presence of a locally advanced growth with extramural spread, a distal location and a short margin of clearance seems to increase the risk of local recurrence, with often distressing symptoms. It is proposed that even if the EEA-stapler offers technical possibilities for anterior resection in these growths, this operation should be restricted to less advanced tumours.

Aged↗
PubMed1984

Ultrastructural morphology and evidence of iodide uptake and protein synthesis in normal human thyroid transplants in nude mice.

Normal human thyroid tissue was xenotransplanted to athymic mice. Well preserved structural properties of the transplants were observed at both light and electron microscopical level. Analysis of the soluble proteins in the transplants by polyacrylamide gel electrophoresis showed that the major fractions were the 19S thyroglobulin, the 27S iodoprotein and a larger protein fraction. Protein synthesizing capacity of the transplants, as measured by in vivo 3H-leucine incorporation into the soluble transplants proteins was demonstrated. The observed 3H-leucine incorporation was in the same magnitude as that found in the original donor tissue at the time of transplantation. Four weeks after transplantation a significant 125I-iodide uptake (2.0%) was observed in the transplants. Corresponding value for the host thyroids was 6.6%. The biological half-time of the accumulated 125I-iodide in the transplants was reduced from 97 days to 38 days between 2 and 4 weeks after transplantation. The biological half-time in the host thyroid increased from 27 days to 32 days during the same period. This investigation shows that normal human thyroid tissue can be transplanted to nude mice with preserved tissue organisation and maintained cellular function.

Animals↗
PubMed1984

Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery.

The endocrine response, and the relief of pain, following the extradural administration of morphine or a local anaesthetic agent bupivacaine (0.5%) were studied for 24h after abdominal surgery and compared with a control group given conventional i.v. morphine after operation. Samples were taken before and at 2, 4, 6, 12 and 24 h after skin incision. Pain relief in both extradural groups was significantly better when compared with the control group. In all three groups, the plasma concentration of cortisol was increased immediately after surgery. Thereafter, significantly lower values were seen in the extradural groups. Plasma adrenaline concentration was lower immediately after surgery only in the group given the extradural local anaesthetic. Plasma noradrenaline concentration remained unchanged after extradural local anaesthesia while an intermediate increase occurred after extradural morphine. Plasma noradrenaline concentration was significantly greater in the controls compared with both extradural groups. Our results indicate that extradural analgesia with a local anaesthetic drug can suppress the increases in the plasma concentrations of the catecholamines and cortisol after surgery. In contrast to extradural local anaesthetic extradural morphine cannot suppress the endocrine response immediately after surgery. However, later in the postoperative period, extradural morphine can suppress the endocrine response, thus indicating that postoperative pain is a factor involved in the stress response following surgery.

Adult↗
PubMed1984

Effect of propranolol and sclerotherapy in bleeding esophageal varices. A case report.

Portal hypertension and variceal bleeding are discussed in relation to the history of a patient with primary biliary cirrhosis. Beta-blockade and sclerotherapy failed to prevent recurrent bleeding and a shunt operation had to be done. In this patient the portal venous pressure increased despite continuous propranolol administration.

Combined Modality Therapy↗
PubMed1984

Choledochoduodenostomy for choledocholithiasis. Indications and functional results.

Choledochoduodenostomy in the prevention and treatment of patients with common bile duct stones has been frequently discussed during several years. The introduction of endoscopic sphincterotomy, with excellent results and low morbidity necessitate further examination of the indications for and the value of this procedure as an adjunct to choledocholithotomy. Twenty patients with a mean age of 73 years have been operated on with choledocholithotomy and subsequent choledochoduodenostomy. In 7 of the patients the anastomosis was performed at a primary operation, in 11 at a secondary and in 2 at a third operation. Seven of the patients had primary bile duct stones, while thirteen had multiple stones, either unextractable or with a doubtful clearance. There was no postoperative mortality and only one early complication, a pneumonia. Eighteen of the 20 patients are free of symptoms postoperatively and have normal liver function tests and verified open anastomoses. Two patients had recurrent postoperative cholangitis, one due to a stricture in the anastomosis, which was reoperated, and one due to multiple retained stones intrahepatically despite an open anastomosis. In conclusion choledochoduodenostomy is easy to perform with low morbidity even in old-aged, high-risk patients. It is a safe and effective method in the prevention of retained or recurrent stones.

Aged↗
PubMed1984

Thyroid hormones, catecholamine and cortisol concentrations after upper abdominal surgery.

Serum and plasma concentrations of thyroid hormones, catecholamines and cortisol as well as oxygen consumption were measured simultaneously in twenty patients in connection with cholecystectomy. Arterial blood samples were taken before surgery and at 2, 24, 48, 72 and 96 h after skin incision. A marked and prolonged decrease in T3 and free T3 concentrations was seen. A minor decrease in T4 was also observed but free T4 remained unchanged. TSH concentration was increased 2 h after skin incision, but at no other occasion. A marked increase in adrenaline and noradrenaline concentrations was observed 2 h after the start of surgery. This increase lasted 24 h for noradrenaline. There was a marked and prolonged rise in plasma cortisol after surgery. The oxygen uptake was higher than the preoperative value during the entire postoperative period. No correlations between thyroid hormones and catecholamines or cortisol or oxygen uptake were found. It is concluded that the most pronounced changes in thyroid hormones and TSH after upper abdominal surgery occur about 24 h postoperatively but catecholamines demonstrate their maximal increase immediately after surgery. The inverse correlation between T3 and catecholamines previously reported in burned patients, with their severe hypermetabolism, it is not present during the moderate hypermetabolism after abdominal surgery.

Abdomen↗
PubMed1983

The EEA-stapling device in anterior resection for carcinoma of the rectum. Technique and early recurrences.

The EEA-autostapling device was used for the anastomosis in 34 patients operated upon with anterior resection for carcinoma of the rectum. The lower border of the tumours was located between 6 and 20 cm from the anal verge and the distal margin free of tumour in the resected specimen was 4 cm (1-8 cm). The anastomoses were within 10 cm from the anal verge in 27 patients. Technical problems occurred in two patients. Eight cases showed incomplete tissue rings but anastomotic leakage was noted merely in four patients (12%). Wound infections were rare (6%). According to Dukes' classification the material comprised 15% Dukes' A, 32% Dukes' B. 38% Dukes' C and 15% Dukes' D. The patients were followed with clinical examinations, rectal palpation and sigmoidoscopy every 3-6 months after the operation. Early local recurrence (median value 5 months) was diagnosed in seven patients (21%). They had in common tumour in the lower part of the rectum, extramural spread and a short distal margin free of tumour. Three of these were classified as Dukes' D, three as Dukes' C and one as Dukes' B. It is concluded that early local recurrence after anterior resection may be due to local tumour spread but a decreased circular radicality may be another reason. The results demonstrate the need to define patients who might be treated by an abdomino-perineal excision even if the EEA-stapler makes a low rectal anastomosis possible.

Aged↗
PubMed1983

Nutritional assessment and clinical course in 112 elective surgical patients.

Recent Swedish reference values in anthropometry and delayed hypersensitivity (DH) were applied in the nutritional assessment of 112 surgical patients. The presence of three or more subnormal variables indicating malnutrition was found in 28% of all patients, and in 52% of those with malignant disease. The anthropometric variables revealed deficits in fat stores and muscle in 26 and 6%, respectively. Plasma protein determinations indicated malnutrition in 6-49%. DH skin testing revealed a subnormal response in 17% of the patients. Ten of the 79 operated patients had postoperative complications. Malnutrition was found preoperatively in six of these. The malnourished patients had a 5.5 times higher complication rate compared to the well-nourished (p less than 0.01). Subnormal values in albumin, prealbumin or DH were associated with a statistically significantly increased complication rate. Regression analysis showed correlations between the anthropometric measurements and plasma protein levels. Furthermore, DH correlated with triceps skin fold, albumin, prealbumin and cholinesterase.

Adolescent↗
PubMed1982

Preferential secretion of triiodothyronine in man.

The directly measured secretion rates of thyroxine (T4), 3,5,3'-triiodothyronine (T3), and 3,3',5'-triiodothyronine (rT3) were compared to the tissue concentrations of these hormones and to the distribution of follicular iodoproteins in 15 patients submitted to thyroid or parathyroid surgery. The T4/T3 and rT3/T3 ratios were higher for thyroid tissue than for the secretion rates, indicating a preferential secretion of T3. The concentrations of T4 and T3 were higher in the 27S iodoprotein fraction than in the 19S thyroglobulin fraction.

Adult↗