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Biomedical subjects

E Amdrup

Publications and source records attributed to E Amdrup.

At least 37 records · Page 2Linked to original sources
PubMed1983

Arhus County Vagotomy Trial: gastric secretory alterations during the first year after selective gastric and parietal cell vagotomy.

Changes in gastric acid secretion during the 1st year after selective gastric (SGV) and parietal cell (PCV) vagotomy for duodenal ulcer disease were studied. Pentagastrin tests were performed preoperatively and 3 months and 1 year after surgery in 383 SGV and 302 PCV patients. Resting juice pH showed after both operations a trend towards the preoperative distribution from 3 months to 1 year. Basal acid output showed a similar pattern. The initial reduction in pentagastrin-stimulated peak acid output (PAOpg) was most pronounced after SGV, but an increase occurred for both operations during the 1st postoperative year. An exception from this was the minority of patients who had a less than 20% initial reduction. They had a further decrease in their PAOpg. No sex difference and no influence of the duration of symptoms could be demonstrated. The patients with less than 20% initial reduction were younger than the other groups, and this applied for both SGV and PCV. The patterns of change in gastric acid secretion during the first year after vagotomy suggest that biologic factors are active, in addition to the effect of the surgical technique.

Adolescent↗
PubMed1983

Arhus County Vagotomy Trial: ulcer recurrence rate related to alterations in gastric acid secretion after selective gastric and parietal cell vagotomy.

Clinical and secretory data were analysed with respect to the recurrence rate for 685 patients treated with either selective gastric vagotomy (SGV) or parietal cell vagotomy (PCV) for duodenal ulcer disease. The duration of ulcer history before surgery was of no importance for the recurrence risk. Men with recurrence after SGV were significantly younger than men without recurrence, but no difference was found for women with SGV or for men and women with PCV. The recurrence rate was not higher for hypersecretors (pentagastrin-stimulated peak acid output (PAOpg) greater than 45 mmol/h) than for patients with lower PAOpg. Resting, basal, and stimulated secretion 3 months after surgery were higher for the patients with recurrence than for the patients without, but only a few of the secretion values were significantly different. A higher recurrence rate was found for the patients with the lowest initial acid reduction, and this trend was more pronounced in the PCV group. With regard to the change in gastric secretion during the first year after vagotomy a significant rise was seen for the PCV patients who developed recurrence in spite of initial reduction of more than 60%. For all SGV patients and the PCV patients with an initial reduction on the average or less, the change in secretion capacity had no influence on the recurrence rate. The findings are in accordance with reports about anatomical limitations for a sufficient PCV in about 20% of the patients.

Adolescent↗
PubMed1983

A predictor analysis of clinical assessment of outcome among patients operated on for duodenal ulcer. A 1-year prospective study.

During a period of 1 year, data concerning life events, non-specific psychological symptoms, individual social history, and ulcer history were obtained for consecutive cases of patients about to have elective surgical treatment for duodenal ulcer. At the 1-year follow-up examination a blind, clinical evaluation was performed (dumping, dyspepsia, recurrence, and Visick grading), and information concerning the 94 patients' assessment of outcome was obtained. A multivariate predictor analysis was performed. Most patients (85%) benefited from treatment. The excess rate of non-specific psychological symptoms indicating impairment remained unchanged. The patients assessments of outcome were correlated with the clinical assessment. A positive correlation was found for women to have dumping and poor Visick grade and for unmarried persons to have postoperative dyspepsia and a poor Visick grade. A negative correlation between a long ulcer history and postoperative dyspepsia and a positive correlation between pyloroplasty and dumping were found. Non-specific psychological symptoms predicted poor clinical assessments. It is suggested that it is relevant to apply the patients' assessments for the purpose of evaluation, supplementing the clinical assessment of the more biomedical aspects of outcome.

Adult↗
PubMed1983

The value of parietal cell vagotomy compared to simple closure in a selective approach to perforated duodenal ulcer. Operative morbidity and recurrence rate.

Of 168 consecutive patients presenting with a perforated duodenal, pyloric or prepyloric ulcer, 123 patients were judged fit or suitable for parietal cell vagotomy (PCV). It was, however, only added to simple closure in 67 patients with a previous history of dyspepsia prone to develop recurrent ulceration, whereas 56 patients with no previous symptoms and an established low risk of recurrence were managed by simple closure only. In the comparable groups, postoperative morbidity did not differ, entailing mortality rates of 4.5% and 5.3% following PCV or simple closure only. An overall clinical grading of 106 patients (91%) followed up (median 4 years, range 1-10 years) revealed equally good results. In patients with previous dyspepsia and an established high recurrence rate if managed by simple closure only, a satisfactory reduction of the recurrence rate was found when PCV was added to suture closure (cumulative recurrence rate 20.7 +/- SD 69 compared to 29% +/- SD 9.4 following simple closure in patients with no previous dyspeptic symptoms). It is concluded that in patients with a perforating duodenal ulcer deemed fit or suitable for PCV, assessed by good clinical judgement, PCV does not carry an added risk and provides a fairly good protection against recurrent ulceration.

Adolescent↗
PubMed1983

Factors influencing mortality in patients with bleeding ulcer. Review of 7 years' experience preceding therapeutic endoscopy.

Over a seven-year period 369 patients with a median age of 67 years were admitted with bleeding peptic ulcer and 41% of the patients required emergency surgery. In 37 low risk patients (24%), defined as patients younger than 70 years without a complicating disease, the mortality rate following emergency surgery was 11% compared to 36% in 118 poor-risk patients (p less than 0.005). A preexisting complicating illness, postoperative complications, and absent history of dyspepsia were calculated to be the three most important factors determining fatal outcome. Age, onset of hemorrhage during hospitalization or prior to admission, previous ulcer surgery, previous bleeds, preoperative endoscopy, site of the ulcer, timing of surgery, and transfusion requirements had comparatively less bearing on the outcome. Hematocrit exceeding 37 in the postoperative period, however, was associated with a significantly increased risk of cardiopulmonary insufficiency. Though surgery controls life-threatening hemorrhage, it is badly tolerated in the many poor-risk patients, and an evaluation of other efficient methods carrying a lower risk of lethal complications seems justified.

Adult↗
PubMed1982

Gastric acid secretion and fasting serum gastrin in patients with duodenal ulcer, prepyloric ulcer or gastric ulcer.

In order to evaluate whether prepyloric ulcer (PPU) could be classified as an intermediate ulcer type between duodenal ulcer (DU) and gastric ulcer (GU), fasting serum gastrin as well as basal and pentagastrin-stimulated acid secretion were studied. The fasting serum gastrin values in the three groups were not significantly different. Patients with PPU and DU showed a higher basal acid output compared to GU patients. The basal acid output in DU patients increased in the last two periods before stimulation, and in the last basal period it was significantly higher compared to PPU patients. Patients with GU showed the lowest basal and stimulated acid output. However, the higher stimulated acid output in DU patients was insignificantly different from that of PPU patients. The results indicate that basal and stimulated gastric acid secretion values in PPU patients are closer to those of DU patients than of GU patients. Furthermore, it is concluded that PPU is a homogeneous ulcer type without secretory overlap with the GU group.

Adult↗
PubMed1981

Recurrent ulcer.

Explore the source record for details and available documents.

Drainage↗
PubMed1981

Pedunculated vagally innervated lesser curve gastric pouch in dogs.

An optimal vagally innervated gastric pouch in dogs is constructed as a pyriform flap from the anterior wall of the stomach. Nerves and vessels are spared in a pedicle from the lesser curvature. The acid secretion pattern is similar to the secretion in nonvagotomized gastric fistula dogs as measured by stimulation with insulin and 2-deoxy-D-glucose. The dogs have been maintained for prolonged periods without deterioration, and the advantages of the model are mentioned.

Animals↗
PubMed1981

The outcome of staged management of complicated diverticular disease of the sigmoid colon.

In a retrospective study, 83 consecutive patients with indication for a staged treatment of complicated diverticular disease were reviewed. There was a considerable overall morbidity rate following construction of the colostomy, colonic resection, and colostomy closure. However, only 58% underwent a resection of the diseased segment, and even fewer (46%) obtained an eventual restoration of the colon continuity. This was primarily due to an unacceptable high mortality rate when patients with general peritonitis were managed by a proximal colostomy and drainage only. Subsequently, advanced age and associated major illness in patients with a planned three-stage management were the most important factors, determining the deficient completion of the staged treatment. Due to the permanence of many transverse colostomies but also to the fact that serious anastomotic complications, including fatal consequences, occurred despite a defunctioning colostomy, one should re-evaluate the need for a proximal colostomy in patients at high risk, considering resection and an end sigmoid colostomy which is the superior permanent stoma if reconstruction fails to come.

Adult↗
PubMed1980

Endoscopic electrocoagulation--an alternative to operative hemostasis in active gastroduodenal bleeding?

Endoscopic electrocoagulation was considered in 69 patients with active gastroduodenal bleeding including 60 patients with peptid ulcer. Permanent hemostasis was achieved in 56 patients (81%), including 16 patients with clinical indication for surgical intervention. Electrocoagulation failed or could not be applied in 13 patients, requiring operative hemostasis in 11 patients. Though no replacing emergency, endoscopic electrocoagulation can be successful, especially if it is applied in quiescent phase of massive, life-threatening hemorrhage, and should be considered before a possible emergency operation, especially in patients with no previous ulcer disease, in the presence of some other severe illness, or in patients of advanced age.

Adolescent↗
PubMed1980

Abnormal duodenal loop demonstrated by X-ray. Correlation to symptoms of dyspepsia.

In 73 patients the occurrence of dyspeptic symptoms were correlated with the presence of a normal duodenal loop (29 patients) and an abnormal duodenal loop (44 patients). An abnormal duodenal loop was associated with a significantly higher incidence of symptoms provoked by meals, vomiting, regurgitation, heartburn, and the irritable bowel syndrome.

Adult↗
PubMed1980

Endoscopic electrocoagulation combined with cimetidine. A pilot study of the applicability in active bleeding from gastroduodenal ulcer.

Preliminary results of endoscopic electrocoagulation combined with Cimetidine are reported in a prospective series of 60 consecutive patients presenting with active bleeding from gastroduodenal ulcer. Coagulation was considered during the initial diagnostic emergency endoscopy, which revealed an accurate identificaion of the bleeding source in 59 patients. Coagulation was accomplished without local complication in 53 patients. Permanent electrohaemostasis was achieved in 47 patients (78%), including 14 patients with clinical indication for surgical intervention. Coagulation could not be applied or failed in 13 patients, requiring operative haemostasis in 11 patients. Though not replacing emergency operation, endoscopic electrocoagulation combined with Cimetidine could be considered an alternative, particularly in patients of advanced age or in the presence of other severe illness.

Adolescent↗