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Biomedical subjects

E Juhl

Publications and source records attributed to E Juhl.

At least 55 records · Page 3Linked to original sources
PubMed1981

Fatal outcome after jejunoileal bypass for obesity.

A review of all literature on jejunoileal bypass for obesity disclosed 282 deaths, corresponding to a mortality rate of 4.2 percent. This rate has been fairly constant through the last 8 years. The causes of death and the postoperative duration are quantified. Pulmonary embolism, mostly early, and liver disease, sometimes late, dominate among the numerous causes of death. Details are too scarcely reported to allow guidance to better results.

Female↗
PubMed1981

Gamma-glutamyltransferase, aspartate aminotransferase and alkaline phosphatase as markers of alcohol consumption in out-patient alcoholics.

Serum activity of gamma-glutamyltransferase, aspartate aminotransferase and alkaline phosphatase were determined in 316 patients attending an out-patients clinic for treatment of alcoholism. The activity of gamma-glutamyltransferase was raised in 34% and that of aspartate aminotransferase and alkaline phosphatase in 18% and 7%. Neither the activity of gamma-glutamyltransferase, aspartate aminotransferase nor alkaline phosphatase showed any significant (P greater than 0.05) correlation with the history of alcohol consumption. The activities of gamma-glutamyltransferase and aspartate aminotransferase were raised significantly more often in patients with recent alcohol consumption than in patients who had abstained for more than 9 days. The concentration of alkaline phosphatase was not significantly (P greater than 0.05) different in these groups. The predictive value of raised and normal activities of gamma-glutamyltransferase, in deciding whether a patient had had recent alcohol consumption or not, was not superior to the predictive value of raised and normal activities of aspartate aminotransferase.

Adult↗
PubMed1981

Clinical relevance of restrictive morphological criteria for the diagnosis of cirrhosis in liver biopsies.

Material obtained by needle biopsy of the liver from 532 patients with cirrhosis who had previously been examined has been re-evaluated using new and more restrictive histological criteria for the diagnosis of cirrhosis. The material was divided into four main groups: (A) cirrhosis, 287 biopsies; (B) probably cirrhosis, 101 biopsies; (C) compatible with but not diagnostic for cirrhosis, 89 biopsies; and (D) probably not cirrhosis, 11 biopsies. Group E consisted of 44 cases where no or insufficient material was available. The survival curves of the groups were significantly (P less than 0.05) different, with group D having the best survival followed by C, B and A. Clinical and laboratory manifestations of cirrhosis (more than five spider naevi, presence of ascites, daily alcohol intake of more than 50 g) were found significantly (P less than 0.05) more often among patients from group A, followed by patients from groups B, C and D. It is concluded that the more restrictive histological criteria for the diagnosis of cirrhosis in liver biopsies have clinical relevance, due to the prognostic and therapeutic implications of the diagnosis. The study also underlines the importance of specifying the criteria used when studies of patients with cirrhosis are reported.

Biopsy↗
PubMed1981

Short-term parenteral and peroral testosterone administration in men with alcoholic cirrhosis.

Serum concentrations of testosterone were measured in 24 male patients with alcoholic cirrhosis during testosterone administration. The purpose was to compare serum concentrations of testosterone during peroral with those during parenteral testosterone administration in these patients. Patients who were injected intramuscularly with a combination of short- and long-acting testosterone (Triolandren, 348 mg testosterone) had median peak values of serum testosterone of about 40 ng/ml, which fell to basal levels after a fortnight. During testosterone propionate injections (84 mg testosterone) every other day, rather constant serum concentrations with median values of about 30 ng/ml were reached after 4 days. Peroral testosterone administration (800 mg micronized free testosterone) each day also resulted in fairly constant serum concentrations after 4 days, and the median values were about 50 ng/ml. No side effects were observed.

Administration, Oral↗
PubMed1981

Diagnosis of Gilbert's syndrome. Reliability of the caloric restriction and phenobarbital stimulation tests.

The diagnostic role of the reduced caloric intake test and phenobarbitone treatment in Gilbert's syndrome was evaluated. During fasting the increase in unconjugated serum bilirubin concentration was significantly higher in patients with Gilbert's syndrome than in normal subjects but not when compared with the increase observed in patients with acute hepatitis, which is the clinically most relevant differential diagnosis. Phenobarbital treatment significantly reduced the level of unconjugated serum bilirubin in patients with acute hepatitis or Gilbert's syndrome, but without any difference within these two groups of patients. The reduced caloric intake test and phenobarbital treatment seem to have low diagnostic specificity in Gilbert's syndrome when the differential diagnosis is that of hepatitis. The fraction of plasma unconjugated bilirubin of total bilirubin was significantly different in all three groups examined. The clinical diagnosis of Gilbert's syndrome can be established with relative certainty if the patients have a mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. Liver biopsy is not mandatory.

Acute Disease↗
PubMed1981

Aspects of the natural history of gastrointestinal bleeding in cirrhosis and the effect of prednisone.

The natural history of gastrointestinal bleeding in cirrhosis has been studied using prospectively collected data of 532 patients included in a randomized clinical trial with a regular follow-up of up to 12 yr. Of the total 199 patients who experienced gastrointestinal bleeding, 95 (48%) bled from esophageal or gastric varices, 67 (34%) bled from peptic ulcer or gastritis, and 37 (18%) had either insufficient evidence of the source (33) or mixed sources (4). In the total group of patients the cumulative percentage of patients in whom varices had been demonstrated of patients in whom varices had been demonstrated by radiography increased from 12 to 90 in 10 yr, while that of bleeding from varices increased from 7 to 40. In 104 patients who bled for the first time during the trial period (trial bleeding patients) the median number of bleeding episodes was one (range 1-8). In these patients the fatality from bleeding from varices was 82%. The risk of rebleeding from varices was 81%, and 4 yr after the first bleeding the cumulative survival had decreased to less than 10%. Rebleeding was significantly less frequent and survival significantly higher in patients bleeding from sources other than varices. Prednisone reduced the occurrence rate of varices, bleeding from varices, and death from bleeding varices in nonalcoholic females without ascites, 40% of whom fulfilled the histologic criteria of chronic active hepatitis. Prednisone significantly increased the occurrence rate of varices inpatient with ascites and of bleeding from varices in alcoholic patients. Prednisone significantly increased the occurrence rate of peptic ulcer in males and in patients without chronic active hepatitis.

Clinical Trials as Topic↗
PubMed1981

Ephedrine as an anorectic: the story of the 'Elsinore pill'.

Obese patients, age 18-60 years, overweight 20-80 per cent, entered a controlled, clinical study comparing the effects of two anorectic drugs, ie a prescription containing ephedrine and caffein ('Elsinore pills') and diethylpropion, with placebo. All 132 patients were instructed in a 1200-kcal diet, and 108 patients completed 12 weeks' treatment. There was a significantly better effect on body weight of diethylpropion (39 patients, median weight loss 8.4 kg, P less than 0.01) as well as of 'Elsinore pills' (38 patients, median weight loss 8.1 kg, P less than 0.01) compared to the effect of placebo treatment ( 31 patients, median weight loss 4.1 kg). Four patients treated with diethylpropion, and four patients treated with 'Elsionore pills' were withdrawn because of complaints of exaltation, tremor and insomnia. Tremor, in some cases only transient, was significantly more frequent in the 'Elsinore pill' group, but no serious side effects were observed.

Adolescent↗
PubMed1981

Causes and characteristics of 500 consecutive cases of jaundice.

During approximately 2 years 106 clinical and routine laboratory parameters were obtained from each of 500 jaundiced patients consecutively admitted to the surgical and medical departments in a hospital covering a third of the hospital admissions in the city of Copenhagen. The patients were classified mainly by morphological criteria (397 patients) or the subsequent clinical course (103 patients) into five major diagnostic categories: acute parenchymal jaundice (113 patients), chronic parenchymal jaundice (97 patients), gallstone disease (76 patients), malignant obstructive jaundice (104 patients), and other causes of jaundice (110 patients). The five major categories covered 23 specific diagnoses. Within 3 months of admission 21% of the patients died, and the mortality varied from 4% in acute parenchymal jaundice to 49% in jaundice due to malignant disease.

Adult↗
PubMed1981

Accuracy of direct cholangiography by endoscopic or transhepatic route in jaundice--a prospective study.

An exact anatomic diagnosis of bile-duct obstruction is a prerequisite for selecting the appropriate management. In a prospective study on patients with clinically suspected obstructive jaundice, the results of direct cholangiography--by endoscopic retrograde or, alternatively, by transhepatic route--were compared with operative findings or liver biopsy or both. Final diagnoses were based on autopsy, operative biopsy, and clinical course. The study included 105 patients, 90 of whom underwent surgery, and allowed a blind and independent comparison between cholangiography and operative findings. The predictive value of a positive test, i.e., cholangiographic visualization of obstruction, was 0.99 and the predictive value of a corresponding negative test was 0.90, with the final diagnoses as reference. For the operated patients the predictive values were calculated as to obstruction (positive test 0.99, negative test 0.89), malignancy (positive test 0.92, negative test 0.89), and common duct stones (positive test 0.96, negative test 0.98). Thus, laparotomy can be avoided in patients in whom direct cholangiography shows no obstruction or an appropriate nonoperative procedure, like transhepatic insertion of a stent or endoscopic biliary surgery elected.

Biopsy↗
PubMed1980

Jejunoileal bypass for obesity--what can we learn from a literature study?

A computerized search was made of all publications on jejunoileal bypass for obesity, recorded in Index Medicus during 1963 to 1977. A total of 171 references, dealing with 6319 patients were usable for the purpose. Fifty-three variables were registered. The great majority of publications is American and published since 1972. Only 20% are joint publications from collaborating surgical and medical departments. The study draws attention to a number of quantitative and qualitative deficiencies in the data and to the less expedient way they are sometimes presented. Principally, this applies to patient number and description, length of observation time, and frequency of complications. Lack of specified criteria for surgical eligibility is common, as is ambiguity in conclusion. It is suggested that recommendations, positive or negative, reflect the authors' subjective attitude, as they are apparently made from the same objective data.

Attitude of Health Personnel↗
PubMed1980

Impaired conversion of prednisone to prednisolone in patients with liver cirrhosis.

Fourteen patients with liver cirrhosis received oral prednisone or prednisolone (0.3 mg per kg) randomised on two consecutive days. Serum prednisone and prednisolone were measured over the following four hours. Mean serum prednisolone concentration after oral prednisone decreased with impaired liver function estimated by galactose elimination capacity (r = 0.64, P less than 0.03). Mean serum prednisolone concentration after oral prednisone in the seven patients with severely impaired liver function was only 53% (P less than 0.05) of that observed in the seven patients with slightly impaired liver function. Conversely, mean serum prednisone concentration after oral prednisone in the patients with severely impaired liver function was 74% higher (P = 0.05) than in patients with slightly impaired liver function. Mean serum prednisolone after oral prednisolone was independent of liver function. As only prednisolone exerts glucocorticoid activity, our results indicate that prednisolone should be preferred to prednisone in the treatment of patients with impaired liver function.

Administration, Oral↗
PubMed1980

Circulating autoantibodies in patients with acute viral hepatitis. Relation to etiology and clinical course.

The prevalences of liver-cell-membrane antibody (LMA), smooth-muscle antibodies, antinuclear antibodies and antimitochondrial antibodies were evaluated in 63 selected patients with acute viral hepatitis of types A, B, and non-A non-B. Twenty patients had a complete, uneventful recovery, 19 patients had fulminant hepatitis, and 24 progressed to a chronic liver disease. Acute-phase and follow-up sera from all patients were tested for antibodies of IgA, IgM, and IgG class. The prevalences of the IgM autoantibodies in the acute-phase sera were not significantly different in the three groups irrespective of clinical outcome. Similar prevalences were found with respect to IgG class; however, antinuclear antibodies of IgG class were predominantly found in acute-phase sera from patients who later progressed to a chronic liver disease. The diagnostic significance of these autoantibodies was stressed by the fact that 85% of the sera with LMA of IgG class and 100% of the follow-up sera with smooth-muscle antibodies of IgG class at a titer at or above 1:128 originated from patients with chronic liver disease. A similar pattern was found for antinuclear antibodies, and testing for all these antibodies of IgA anad IgM class did not yield any further information. In some serum samples LMA could be found independently of smooth-muscle antibody and vice versa, indicating the essential difference between these two autoantibodies.

Acute Disease↗
PubMed1980

Human leucocyte antigens in patients with alcoholic liver cirrhosis.

No significant differences in the frequencies of HLA-B8, -B40, and other HLA-A, -B, and -C phenotypes were found among patients with histologically verified alcoholic cirrhosis compared with normal controls when the p values were multiplied by the number of comparisons. This was found both in the present study of 45 patients and in the combined data of this and three other similar studies. However, these findings do not rule out that alcoholic cirrhosis might be associated with HLA factors (for example. HLA-D/DR antigens) controlling immune responses.

Adult↗