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Biomedical subjects

D Holmlund

Publications and source records attributed to D Holmlund.

At least 19 recordsLinked to original sources
PubMed1987

Long-term effects of surgery for normocalcaemic hyperparathyroidism.

A retrospective study of the long-term effects of surgery for normocalcaemic hyperparathyroidism in 82 patients is presented. The median postoperative follow-up time was 96 months. In most of the patients recurrent renal calculi had been the main preoperative symptom, and intermittent peaks of hypercalcaemia were recognized in more than 50% of them. Of the 19 patients with severe tendency to calculus formation, 12 appeared to have been cured by parathyroidectomy. These cured patients were found at operation to have parathyroid adenoma or hyperplasia, or even normal glands. Preoperatively depressed renal function normalized in about 50% of cases, as assessed by the desmopressin test. No patient had paralysis of the recurrent laryngeal nerve, and all were normocalcaemic during follow-up. Parathyroid surgery should be considered for this category of patients, although it is very difficult to distinguish between those who stand to benefit and those who do not.

Adult↗
PubMed1986

[Comparison of indomethacin and ketobemidone as analgesics in acute cholecystitis].

In an open, randomized prospective clinical trial the analgesic effect of indomethacin and ketobemidon was compared in 67 patients with acute cholecystitis (28 received 5 mg ketobemidon and 39 received 50 mg indomethacin). Both drugs showed a good and significant pain relief, exhibiting no significant difference in the analgesic effect and no serious adverse reactions. It was concluded that indomethacin administered intravenously is an alternative to ketobemidon intravenously in the treatment of pain resulting from acute cholecystitis and may offer some advantages.

Acute Disease↗
PubMed1985

Prevention of post-operative infection in appendicectomy by single dose intravenous metronidazole. An open prospective randomised study.

In an open prospective randomized study of appendicectomy, single-dose (1 g) intravenous metronidazole prophylaxis (and continued metronidazole plus nalidixic acid in perforated appendices) resulted in a lower overall post-operative infection rate (1.4%) than no prophylaxis and doxycycline therapy in the case of perforation (16%, p less than 0.025). In patients with an unperforated appendix no infections occurred after single-dose metronidazole prophylaxis as opposed to 8.2% infections in untreated controls (p less than 0.025).

Adolescent↗
PubMed1985

Single-dose intravenous metronidazole v. doxycycline prophylaxis in colorectal surgery. An open prospective, randomized trial.

In an open prospective, randomized study of antimicrobial prophylaxis in colorectal surgery, using a single intravenous dose, metronidazole (1 g) was more effective than doxycycline (0.2 g). The difference in infection rates (2/41 = 5% v. 7/33 = 21%) was statistically significant. Prolonged administration of either agent (2-7 days) yielded results comparable to those with single doses. Five emergency cases were admitted to the study. In two of them, a metronidazole-based therapeutic regimen prevented postoperative infection, whereas infection occurred in all 3 patients given doxycycline therapy. The total infection rate after elective surgery was 4% with metronidazole and 25% with doxycycline prophylaxis. The infections in the metronidazole group were superficial and caused by Escherichia coli, whereas half of the infections in the doxycycline group were intra-abdominal and due to intestinal aerobic and/or anaerobic bacteria. In contrast to doxycycline, therefore, metronidazole prevented postoperative anaerobic infection and was associated with low incidence of aerobic infection.

Adult↗
PubMed1984

Indomethacin as prophylaxis against recurrent ureteral colic.

In a prospective, randomized study, the prophylactic effect of indomethacin (150 mg daily) in regard to recurrence of ureteral colic was investigated in 78 patients. Severe recurrent attacks were experienced in 78 patients. Severe recurrent attacks were experienced by 4 of 37 patients in the test group and by 16 of the 41 controls without indomethacin. The mean duration of recurrent pain including the severe attacks was 5.6 +/- 1.1 hour/patient/week in the test group and 12.5 +/- 2.9 in the control group. Passage of stone within 7 days was not influenced by indomethacin (22/37 and 25/41 cases). Indomethacin administration for 7 days after an acute attack of ureteral colic thus reduced the frequency of severe attacks and the total duration of recurrent pain, without influencing the stone passage.

Adult↗
PubMed1984

Biliary microflora in acute cholecystitis and the clinical implications.

A prospective bacteriologic investigation was made in 43 consecutive patients (mean age 63 years) operated on for acute cholecystitis. Gallbladder bile and wall were cultured, using four methods and with special attention to optimal anaerobic technique. Cultures were positive in 72% of the patients, yielding a wide variety of species (21 species among 48 isolates). Anaerobes constituted 23% of the isolates. Cultures from gallbladder bile and from gallbladder wall gave almost identical results, as did sampling at the beginning and at the end of cholecystectomy. Bactibilia was found in all patients operated on within 48 hours after the onset of symptoms. Bactibilia and postoperative septic complications showed statistically significant correlation with high patient age. Bactibilia and gallbladder gangrene were significantly correlated with preoperative temperature greater than 38.5 degrees C. There was coincidence of strains isolated from local wound sepsis and from peroperatively sampled gallbladder bile. Adequate preoperative or peroperative antibiotic therapy according to susceptibility testing was associated with significantly reduced rate of postoperative septic complications. The study indicates that bacteria are present early in the course of acute cholecystitis and that they are causally important for postoperative morbidity and mortality.

Acute Disease↗
PubMed1983

Antidiuretic hormone levels and the effect of indomethacin on ureteral colic.

We treated 25 patients with ureteral colic and urographically verified stones with 50 mg. indomethacin intravenously. Pain was relieved completely in 17 patients, while in 8 incomplete or no pain relief was achieved after the infusion of indomethacin. Patients completely relieved of pain had significantly higher levels of antidiuretic hormone in plasma before the infusion of indomethacin (18.2 plus or minus 3.4 pg./ml.) than patients with incomplete or no pain relief (7.2 plus or minus 1.3 pg./ml.) (p less than 0.01). These findings indicate that the volume status and/or the level of antidiuretic hormone may be of critical importance for pain relief after infusion of indomethacin in patients with ureteral colic.

Adult↗
PubMed1983

Separation of sutured tendon ends when different suture techniques and different suture materials are used. An experimental study in rabbits.

Calcaneal tendons in rabbits were divided and then sutured with varying suture techniques and suture materials. The separation of the tendon ends after suturing was registered with an X-ray technique--the tendon ends being identified by thin steel wires. Independently of the suture techniques and the suture materials a biphasic separation of the tendon ends was registered. The first separation took place during the first 4-5 days while the second separation began after 20-24 days. A small initial separation seems to indicate that the tendon suture used is adequate. The initial separation can therefore be used to evaluate a suturing technique and how the result is influenced by the suture material used. In the present study we could show that steel wire was ideal for a Bunnell suture. Prolene and Ethiflex cannot be recommended. A suture technique with a single short loop gave good results with all suture materials. Dexon ligatures placed around the tendon ends according to Schink in order to prevent the strands of the suture from cutting the tissue, did not reduce the initial separation. When a complex suture technique, like a Bunnell suture, is used the physical properties of the suture material influence the result. With a simple suture technique, a single short loop, good results can be achieved with every suture material.

Animals↗
PubMed1983

Separation of tendon ends after suture of achilles tendon.

Ten patients treated for an acute rupture of the achilles tendon were studied. During the operation a marker was attached to each tendon end. The postoperative separation of the markers was studied by repeated X-ray examinations. Despite immobilization a small initial separation was found during the first 4 days, followed by a period of no separation. After about 20 days a second separation started. No re-ruptures occurred. Both in the rabbit and in man a small initial separation of sutured tendon ends seemed to indicate an adequate tendon suture and therefore also a good tendon healing.

Achilles Tendon↗
PubMed1983

Experimental evaluation of immobilization in operative and non-operative treatment of Achilles tendon rupture. A radiographic study in the rabbit.

Achilles tenotomy in rabbits was followed by operative or non-operative management. Various immobilization periods were used (0, 7, 16 and 35 days). Steel markers were fixed on the tendon ends to allow continuous X-ray monitoring of the distance between them. The separation of the tendon ends followed a biphasic course, with (I) and initial separation, 0-7 days, (II) no separation, 8-12 days, and (III) late separation, 22-35 days, irrespective of the therapeutic procedure. When the tendon was sutured, the initial separation was small if the leg was immobilized, but large if no immobilization was used. When no suture was applied, the initial separation was always large, whether or not the leg was immobilized. Large initial separation of the tendon ends always resulted in disturbed healing of the tendon. The final tendon end separation was independent of duration of immobilization. Good healing of cut Achilles tendon in rabbits thus requires immediate suture and immobilization for at least 7 days. The possible validity of these observations for tendon rupture in man offers interesting prospects.

Achilles Tendon↗
PubMed1983

Cholescintigraphy: a valuable diagnostic method in acute cholecystitis.

In 91 patients (36 men, 55 women) who were hospitalized with symptoms of acute cholecystitis, cholescintigraphy was performed with 99m-Tc-ethyl-IDA, in order to evaluate the method in the diagnosis of acute inflammatory disease of the gallbladder. Five groups of patients were recognized: (A) abnormal scintigraphy and verified gallbladder disease, (B) abnormal scintigraphy without verified gallbladder disease (false positive). (C) normal cholescintigraphy but cholelithiasis (false negative), (D) normal cholescintigraphy and no gallbladder disease, and (E) cholescintigraphy in icteric patients. In the diagnosis of acute cholecystitis the sensitivity was 92% and the specificity was 88%. Cholescintigraphy is a useful method for proving or disproving a diagnosis of acute cholecystitis with non-patent cystic duct. It does not reveal calculi in biliary ducts or in a gallbladder with patent cystic duct. In icteric patients, cholescintigraphy has restricted usefulness at serum bilirubin level around 120 mumol or more.

Acute Disease↗
PubMed1982

Indomethacin by intravenous infusion in ureteral colic. A multicentre study.

In a multicentre study the analgetic effect of indomethacin in ureteral colic was analyzed. Indomethacin, which inhibits the synthesis of prostaglandin, was given by intravenous infusion in a dose of 50 mg. The study comprised 198 patients with 252 attacks of ureteral colic. Satisfactory relief of pain was obtained in 212 attacks (84%). No serious side effects of indomethacin were observed. The pain recurred within four hours in only 15 patients (7%), in 12 of them during a diagnostic intravenous pyelography. The relief of pain may be explained by reduced glomerular filtration pressure and/or diminished urinary excretion, causing rapid fall in the renal pelvic pressure and in the tension of the pelvi-ureteral wall. A low extracellular volume of fluid in a patient with ureteral colic may be essential for analgetic action of indomethacin.

Adult↗
PubMed1981

Serum antibodies against Escherichia coli and Proteus mirabilis after different types of operations.

The serum antibody titer against Escherichia coli and Proteus mirabilis before and after different types of operations was studied in 105 adult patients. The different operations were: pyelo- or ureterolithotomi (32); ileal conduit urinary diversion (20); cholecystectomi (34); operation in the thyroid area (10); operation of varicose veins of the legs (9); and colectomies (10). High serum antibody titers against E. coli were found in 16% of the patients preoperatively. Antibody titres against P. mirabilis were high in 19% of the patients with urinary tract calculus but in none of those without urological disease. The antibody titre against E. coli and/or P. mirabilis increased significantly more often after operation in the urinary tract or colon than after the other operations. Increase of antibody titers were more often seen in patients who preoperatively had normal titres. A normalization of the titers was seen during the following 12 months and in most of those patients within the first 3 months.

Adolescent↗